Showing papers in "Psychiatric Services in 1978"
TL;DR: The authors present recommendations for reducing staff stress and subsequent burnout, including allowing more chances for temporary withdrawal from direct patient care and changing the function of staff meetings.
Abstract: To determine the characteristics of staff burnout and ways of coping with it, the authors gathered data on institution-related and personal variables for 76 staff members in various mental health facilities in the San Francisco area. A correlational analysis revealed a large number of statistically significant findings. For instance, the longer staff had worked in the mental health field, the less they liked working with patients, the less successful they felt with them, and the less humanistic were their attitudes toward mental illness. The authors present recommendations for reducing staff stress and subsequent burnout, including allowing more chances for temporary withdrawal from direct patient care and changing the function of staff meetings.
600 citations
TL;DR: Two-year outcome data from a study comparing two kinds of treatment given similar groups of young, newly diagnosed, unmarried schizophrenic patients deemed in need of hospitalization are reported, showing significant differences in readmissions or levels of symptomatology.
Abstract: Two-year outcome data from a study comparing two kinds of treatment given similar groups of young, newly diagnosed, unmarried schizophrenic patients deemed in need of hospitalization are reported. The experimental program, Soteria, is a nonmedical, psychosocial program with minimal use of antipsychotic drugs; it is staffed by nonprofessionals and located in a home in the community. The control program is a short-stay, crisisoriented inpatient service in a community mental health center where neuroleptic drugs are the principal treatment. The experimental group had significantly longer initial stays, and only 8 per cent received neuroleptics during their initial admission. Over the two-year follow-up period, there were no significant differences between the groups in readmissions or levels of symptomatology. However, experimental subjects significantly less often received medications, used less outpatient care, showed significantly better occupational levels, and were more able to live independently.
120 citations
TL;DR: The authors contend that families of schizophrenics have received too little help from mental health professionals, even though in many cases families are the real primary care agents for long-term patients released from mental hospitals.
Abstract: The authors contend that families of schizophrenics have received too little help from mental health professionals, even though in many cases families are the real primary care agents for long-term patients released from mental hospitals. They discuss some of the problems that occur in living with a long-term patient and describe mutual-support and advocacy groups that relatives have formed. They emphasize that mental health professionals can help families of schizophrenics by providing practical, realistic advice on how to deal with the illness, by offering empathy and support rather than placing blame, and by working to ensure that there are adequate treatment and rehabilitation services available.
59 citations
TL;DR: Significant but low correlations between satisfaction and success indicate that satisfaction ratings cannot replace success ratings or other outcome indicators in assessments of quality of care.
Abstract: The authors studied the relationship between patient satisfaction and success of treatment in a group of out-patients consecutively admitted to two community mental health centers in California in 1975. The study is based on patient ratings of their satisfaction with treatment and the success of treatment at the second visit, the last visit, and follow-up, as well as on therapists' ratings of treatment success at the second visit and the last visit. At both time points the therapists' mean ratings of treatment success were significantly lower than the patients'. Significant but low correlations between satisfaction and success indicate that satisfaction ratings cannot replace success ratings or other outcome indicators in assessments of quality of care.
58 citations
TL;DR: The authors believe the public confusion about who is criminally insane arises from the media's emphasis on prior history of mental treatment of individuals committing violent and bizarre crimes, and from misunderstanding of the role of mental health professionals in criminal proceedings.
Abstract: The authors interviewed 413 residents of New York State in a study of public perceptions of the criminally insane. They found that the criminally insane are generally considered dangerous, harmful, and violent, and as a class they are feared and rejected by society far more than are the mentally ill. However, none of the individuals identified by study respondents as criminally insane were legally classified as such. The authors believe the public confusion about who is criminally insane arises from the media's emphasis on prior history of mental treatment of individuals committing violent and bizarre crimes, and from misunderstanding of the role of mental health professionals in criminal proceedings.
33 citations
TL;DR: The authors suggest the development of therapeutic research units in which patients would be sheltered, protected from their impulses, and taught how to become self-sufficient.
Abstract: Psychiatric staff at Bellevue Hospital have a list of disruptive patients who apply frequently for readmission but refuse to participate in the hospital's therapeutic program. The staff feel that the patients have received "maximum hospital benefit" and should not continue to be readmitted. The authors studied the charts of 23 patients on the list and found that most were young men with few vocational or social skills. They responded to stress with rage, often augmented by alcoholism or drug abuse. As one way of helping these unwanted patients, the authors suggest the development of therapeutic research units in which patients would be sheltered, protected from their impulses, and taught how to become self-sufficient.
29 citations
TL;DR: The authors obtained demographic and diagnostic data on 377 psychiatric patients seen consecutively on the emergency ward and compared those admitted to the holding unit with those released or hospitalized, finding the three groups were demographically similar but the patients in the holding group fell between the other two groups in severity of psychopathology.
Abstract: Patients identified as psychiatric cases on the emergency ward of a 1036-bed teaching hospital are handled in one of three ways: released with outpatient referral, admitted to a psychiatric inpatient facility, or hospitalized in a general medical holding unit with a 24-hour stay. The authors obtained demographic and diagnostic data on 377 psychiatric patients seen consecutively on the ward and then compared those admitted to the holding unit (83) with those released (193) or hospitalized (101). The three groups were demographically similar but the patients in the holding group fell between the other two groups in severity of psycho- pathology. More than half the patients admitted to the holding unit were released the following day. The authors discuss the advantages of overnight admission as an alternative to hospitalization or release.
25 citations
23 citations
TL;DR: The findings of both studies suggest that there is a significant relationship between an increasing number of aftercare visits and a reduced liklihood of rehospitalization, especially among the more chronic patients.
Abstract: Focusing on a sample of 421 patients who made from one to 65 visits to an aftercare clinic, the authors replicated and extended an investigation of the effectiveness of psychiatric aftercare for patients discharged from hospital settings. A total of 167 of the patients were rehospitalized at least once during the follow-up period. The findings of both studies suggest that there is a significant relationship between an increasing number of aftercare visits and a reduced likelihood of rehospitalization, especially among the more chronic patients. The authors emphasize the need for further studies in which patients are interviewed directly about their perceptions of aftercare.
22 citations
TL;DR: The Moos Ward Atmosphere Scale was administered on a 45-bed psychiatric unit in a Veterans Administration Hospital to assess how staff, patients, and observers viewed the ward and to clarify what goals staff had and what changes they wished to make.
Abstract: The Moos Ward Atmosphere Scale was administered on a 45-bed psychiatric unit in a Veterans Administration Hospital to assess how staff, patients, and observers viewed the ward and to clarify what goals staff had and what changes they wished to make. Comparisons of staff's ratings of the existing milieu and of what an ideal milieu should be showed they wiched to improve the ward in the areas of patient involvement, support, spontaneity, order and organization, program clarity, and staff control; methods for making such changes became apparent. When the scale was administered again seven months later, respondents' ratings indicated that in general there had been substantial positive changes in all six areas. The authors believe the Moos scale is an invaluable aid in making and measuring change in a ward environment.
21 citations
TL;DR: It is maintained that staff acceptance of total responsibility for preventing suicide may achieve short-term safety at the expense of increased long-term risk, and that suicides can occur even when all reasonable precautions have been taken.
Abstract: The authors cite seven case histories of inpatients who committed suicide over a five-year period and analyze staff reaction and the changes in policy and procedures that followed. They conclude that staff feelings of guilt and failure brought about by inhospital suicides may result in the implementation of procedures designed to decrease risk, but that such procedures would not necessarily have prevented the suicide that led to their introduction. They maintain that staff acceptance of total responsibility for preventing suicide may achieve short-term safety at the expense of increased long-term risk, and that suicides can occur even when all reasonable precautions have been taken.
TL;DR: The author advocates a program of continuous, or nearly continuous, neuroleptic medication, combined with counseling and social and crisis services, which would appear to improve safety, precision, and reliability of medication.
Abstract: Mental health services in the 1960s reflected then-current beliefs in the effectiveness of crisis-oriented services and broad social programming to treat and even prevent serious mental disorders. The result was an unwarranted emphasis on the single-episode user of services and lack of interest in patients such as schizophrenics who needed repeated services. Numerous more recent studies indicate that many cases of schizophrenia have a heritable biological component and respond well to neuroleptic medication. For effective outpatient treatment of schizophrenics who might otherwise be repeated users of hospital service, the author advocates a program of continuous, or nearly continuous, neuroleptic medication, combined with counseling and social and crisis services. The patient would be educated to take a role in self-regulation of medication, within a prescribed range, which would appear to improve safety, precision, and reliability.
TL;DR: The Appalachian Regional Comprehensive Alcoholism Program in Beckley, West Virginia, was established in 1972 to meet the needs of a four-county catchment area and took into account the special cultural and economic characteristics of the population to be served.
Abstract: The Appalachian Regional Comprehensive Alcoholism Program in Beckley, West Virginia, was established in 1972 to meet the needs of a four-county catchment area. In designing the program, planners to...
TL;DR: New procedures for conducting competency evaluations were adopted in Connecticut in 1975 as a result of a change in the state law, and the authors describe the procedures and discuss the benefits and potential problems.
Abstract: New procedures for conducting competency evaluations were adopted in Connecticut in 1975 as a result of a change In the state law. The accused person is now evaluated in the setting in which he finds himself by virtue of his conflict with the criminal fustice system, rather than automatically being remanded to the state hospital for evaluation. The criteria used are legal rather than medical-psychiatric, and the evaluations are conducted by a mental health team consisting of a psychiatric social worker, a psychiatrist, and a psycholo- gist. The authors describe the procedures and discuss the benefits deriving from them, as well as some of the real and potential problems.
TL;DR: The authors describe ways to identify children who are born prematurely or who are sickly or handicapped and suggest a number of primary prevention techniques that can reduce parental stress and help prevent child abuse.
Abstract: The authors review the literature on child abuse and present evidence demonstrating that children who are born prematurely or who are sickly or handicapped are at high risk for child abuse. The authors describe ways to identify such children and suggest a number of primary prevention techniques that can reduce parental stress and help prevent child abuse. The techniques include day-care programs for handicapped children, mothers' social clubs, and lay health visitors to give support and impart proper maternal attitudes.
TL;DR: After several abortive attempts, a state hospital and a community mental health center located in the same county made a more successful attempt to improve continuity of care.
Abstract: After several abortive attempts, a state hospital and a community mental health center located in the same county made a more successful attempt to improve continuity of care. A study of 78 discharged hospital patients identified several problems in the continuity-of-care system. A liaison team made up of a social worker from the hospital and a psychiatric nurse from the center was set up to carry out such tasks as contacting county residents admitted to the hospital, participating in treatment and discharge planning, and contacting patients who did not keep aftercare appointments. The program had several positive results; the authors believe they were related to such factors as an objective definition of the problems, administrative cooperation, and strong linkage, through a middle-management team, between the liaison team and top-level management and between the hospital and the center.
TL;DR: The primary goal of the project is to develop a set of criteria that can be used to estimate the probability of a patient’s committing a violent act against another person.
Abstract: UWith a grant from the Hogg Foundation for Mental Health of the University of Texas, the Texas Department of Mental Health and Mental Retardation is conducting a research project on the dangerousness of mental patients. The primary goal of the project is to develop a set of criteria that can be used to estimate the probability of a patient’s committing a violent act against another person. In the initial phase of the research project, a pilot study was conducted to provide baseline information on Texas forensic patients. The sample included 101 consecutive admissions to the maximum-security unit of Rusk State Hospital over a two-month period. The unit, which provides the inpatient psychiatric services for all forensic patients admitted through criminal courts in Texas, typically houses approximately 300 patients. As part of the project, instruments were developed to provide detailed social histories of the patients’ childhood, adolescence, and adult life. Of special interest was the six-month period prior to hospital commitment. Data were gathered concerning the circumstances of the patients’ alleged criminal offenses-for example, type of offense, the weapon used, location of the crime, and use of alcohol or drugs in conjunction with the crime. Data were also gathered about victims’ age, sex, race, and extent of personal injury. All medical information that is obtained by hospital clinicians as part of the routine admission process was recorded, including medical history and data from medical examinations, lab tests, and electrolyte testing. Extensive psychologi-
TL;DR: A movement therapy group for long-term geriatric patients in a convalescent home was established to promote socialization and expression of feelings, partly by recognizing even the most minimal participation in the group.
Abstract: After several weeks of orientation with staff, the author, a registered dance therapist, established a movement therapy group for long-term geriatric patients in a convalescent home. The purpose was to promote socialization and expression of feelings, partly by recognizing even the most minimal participation in the group. Many patients were severely depressed and disoriented; most were in wheel chairs. Three months later a second group, functioning at a higher level, was formed. During the first six months, patients showed increases in verbalization and spontaneous expression of feelings, in interaction, and in assertiveness.
TL;DR: An exploratory study to compare patients, therapists, and inpatient staff's perceptions of inpatient treatment found little agreement on the identification of patients' symptoms or on assessments of change for those cases in which they agreed on the symptoms.
Abstract: Data were gathered on 199 consecutive admissions to a community mental health center in an exploratory study to compare patients', therapists', and inpatient staff's perceptions of inpatient treatment. The three groups showed little agreement on the identification of patients' symptoms or on assessments of change for those cases in which they agreed on the symptoms. There was also little concurrence between the inpatient staff and therapists in reporting which major therapeutic modalities they used, and in identifying cases in which there were communication problems between therapist and staff. However, neither the use of different treatment approaches nor the existence of communication problems was related to longer lengths of stay or poorer outcomes. The authors note that many of the findings are consistent with comparisons elsewhere of patients' and caregivers' perceptions of outpatient psychotherapy and general medical care.
TL;DR: Elements of his family therapy program that he feels contribute to its success include helping the family focus on the past in relation to present concerns, investigating ways the family reacts to the illness, and asking the patient why he is ill.
Abstract: The author, a family therapist, believes that family relationships, behavior patterns, and the manner of responding to stress are important causal factors in physical illness and in health. Using case examples from his own practice as well as a review of the literature, he demonstrates ways that families help create and complicate physical illness. Elements of his family therapy program that he feels contribute to its success include helping the family focus on the past in relation to present concerns, investigating ways the family reacts to the illness, asking the patient why he is ill, conducting classes in stress release, and helping the family change patterns of interaction.
TL;DR: The authors used the records of the continuing-care program at a large public hospital in Los Angeles to determine the success of referrals for aftercare and found patients were most likely to keep their first appointment if it was set up for within three days of release from the hospital.
Abstract: The authors used the records of the continuing-care program at a large public hospital in Los Angeles to determine the success of referrals for aftercare. A total of 552 patients discharged during an eight-month period were referred for continuing care; 418 of the patients kept their first appointment. Patients were most likely to keep their first appointment if it was set up for within three days of release from the hospital and if it was confirmed before discharge from the hospital. If an appointment could not be arranged within three-days, a phone call to the patient improved the referral completion rate.
TL;DR: The general lack of educational resources reflects the traditional dispositional model of emergency psychiatry, the authors say, with its emphasis on briefly evaluating the patient and referring him elsewhere for services.
Abstract: The authors surveyed psychiatric residency programs to see what educational resources were available to residents assigned to provide emergency services during evening and nighttime hours. Almost half the sample of 89 programs assigned first-year residents to provide emergency care. The primary immediate means of support for the residents was telephone assistance, in 49 per cent of the programs, or the presence of a non-psychiatrist professional, in 35 per cent. The general lack of educational resources reflects the traditional dispositional model of emergency psychiatry, the authors say, with its emphasis on briefly evaluating the patient and referring him elsewhere for services; current training practices cannot meet the goals of the crisis system model in which a comprehensive treatment program is begun in the emergency room.
TL;DR: Treatment was helpful in all areas except promoting economic independence; it was most effective in reducing perceptual-cognitive dysfunctioning, emotional distress, and interpersonal difficulties.
Abstract: A study of the day hospital program of the Veterans Administration was aimed at determining how well patients functioned three months after admission in relation to nine treatment goals, and how much they improved between admission and follow-up. The study group consisted of 1410 patients admitted to 34 VA day hospital programs; follow-up interviews were conducted with 70 per cent of them. At follow-up less than 10 per cent of the patients showed significant problems related to delusions, hallucinations, irrelevant speech, suicidal preoccupation, antisocial behavior, drinking, poor hygiene and eating habits, and assaultiveness. However, almost afourth were significantly withdrawn, about a third were anxious, and three-fifths were not self-supporting. From the perspective of improvement during the three months, the study showed that treatment was helpful in all areas except promoting economic independence; it was most effective in reducing perceptual-cognitive dysfunctioning, emotional distress, and interp...
TL;DR: A chaplain, a psychiatrist, and a social worker developed a program to train clergy in more effective mental health case management, counseling, and referral skills, and to sensitize mental health center professionals to the work of the clergy in mental health.
Abstract: A chaplain, a psychiatrist, and a social worker developed a program to train clergy in more effective mental health case management, counseling, and referral skills, and to sensitize mental health center professionals to the work of the clergy in mental health. The program consists of 12 two-hour meetings conducted by a clinician and a chaplain once a week. In the first four meetings, clergy are trained to use a self-report personal-data kit with individuals presenting with emotional problems. In the next eight meetings, clergy make case presentations that are used as a basis for consultation and group discussion. The project has established a firm basis for collaboration between clergy and mental health center staff in providing care.
TL;DR: The author discusses some of the barriers encountered in attempting to transform New York City's fragmented mental health services into a comprehensive, nondiscriminatory, and accessible system.
Abstract: The author discusses some of the barriers encountered in attempting to transform New York City's fragmented mental health services into a comprehensive, nondiscriminatory, and accessible system. Among the barriers he identifies are the belief that more money alone will solve the problem; the uneven distribution of funds among the boroughs of the city and the resistance of existing agencies to redistribution; and the way in which reimbursement patterns shape the kinds of services provided. He believes the single most effective stimulus to the development of an integrated system of care would be a requirement that eligibility for reimbursement under Medicaid be based on a facility's participation in a comprehensive system of care. He emphasizes the need to remove social, rehabilitation, and other services from under the mental health umbrella and to obtain other sources of funding for them; the need for local governance of services; and the need to provide work opportunities for the more seriously disabled.
TL;DR: Ten patients in a Veterans Administration hospital who had been diagnosed and treated as schizophrenic were rediagnosed as having bipolar affective illness and were shown to be responsive to lithium.
Abstract: Ten patients in a Veterans Administration hospital who had been diagnosed and treated as schizophrenic were rediagnosed as having bipolar affective illness and were shown to be responsive to lithium. The authors feel that the diagnosis of schizophrenia is made too frequently and often is made with inadequate information. A further complicating factor in diagnosis is that some patients exhibit schizophrenia-like symptoms during the acute manic phase. The authors found that valuable aids to rediagnosis of such patients include a good premorbid and interepisodic adjustment, a history of depressive episodes, a family history of affective disorder, and a favorable response to a therapeutic trial on lithium carbonate.