Outpatient Psychiatric Care Research Articles

The Relationship Between Sex Roles, Marital Status, and Mental Illness

In modern Western societies women have higher rates of mental illness than men. In this article it is suggested that this difference can be attributed to the role of married women. More specifically, it is shown that married women have noticeably higher rates of mental illness than married men. In contrast, it is shown that when single women are compared with single men, divorced women with divorced men, and widowed women with widowed men, these women do not have rates of mental illness that are higher than their male counterparts. In fact, if there is a difference within these marital categories, it is that women have lower rates of mental illness. In a recent paper Gove and Tudor (1972) looked at the proportion of men and women who were mentally ill in modern industrial societies as indicated by community surveys, first admissions to mental hospitals, psychiatric treatment in general hospitals, psychiatric outpatient clinics, private outpatient psychiatric care, and psychiatric illness in the practices of general physicians. All of these sources indicated that women are more likely to be mentally ill than men. As most studies indicate that never married and formerly married persons have higher rates of mental illness than those who are married, one might expect that the difference between the rates of men and women could be attributed to unmarried women having extremely high rates of mental illness. This would conform to the stereotype of the carefree bachelor and the rejected spinster (or former wife). However, in this article I will indicate that this expectation is incorrect and that it is the relatively high rates of mental illness in married women that account for the higher rates of mental illness among women. Furthermore, I will attempt to show that it is the roles confronting married men and women that account for the high rates among women and not some other factor such as women being biologically more susceptible to mental ill-

The Chronic Psychiatric Out-Patient in a General Hospital Setting

The review of 65 cases from our psychiatric out-patient clinic in the general hospital setting reflects the interaction of several factors in determining chronicity. Chronic patients tend to have a poorly developed ego structure, which often reflects family psychopathy, and is in turn reflected by impaired social skills and a limited capacity to recover after a severe life stress. Emotional turmoil is frequently manifested by psychophysiological disturbances. There is usually a long delay before correct diagnosis is made and referral for psychiatric management is arranged. In the past our psychiatric out-patient care was also unsatisfactory and was reflected chiefly by over - reliance on drugs and limited support. At present we provide a greatly improved psychiatric out-patient service, based on sound psychotherapeutic principles. This can serve as a model for other psychiatric out-patient departments. It is hoped that continuing education will influence our physician colleagues to earlier diagnosis in these special cases. The application of mental health principles in our community programs will help to strengthen family structure and reduce the toll of human suffering. The better utilization of our existing psychiatric skills offers the best hope for the reduction of our chronically ill population.

ACTIVITY IN INITIAL INTERVIEWS WITH LOWER-CLASS PATIENTS.

Psychotherapy of lower social class patients has been under study at Temple University Medical Center for two years. Review of the literature reveals that much has been written about the therapy of the lower social class patients * since the pioneering study of Hollingshead and Redlich. 16 Most of the studies agree that the lower class patient is less likely to seek psychiatric outpatient care, and when referred many are likely to drop out of treatment in a very short time. This high drop-out rate has been an important focus of the project. Rosenthal and Frank 23 at the Phipps Psychiatric Clinic reported that 47% of their patients stopped treatment in less than six sessions; Overall and Aronson 20 found that 57% of the patients at University of Maryland Psychiatric Institute drop out after the first interview; Bahn and Norman 1 presenting

Location and Outpatient Psychiatric Care

IN 1954-55 93 percent of the professional services in Minnesota's outpatient psychiatric clinics were concentrated in metropolitan areas, and only 7 percent were provided for the 55.7 percent of the State's population residing in nonmetropolitan areas (1). Today, less than 3 years after passage of the Minnesota Community Mental Health Services Act of 1957, outpatient psychiatric care is available to 45 percent of all State residents within their own communities.. As provided in the act, more than half of Minnesota's 87 counties have received State grants-in-aid to esta.blish local mental health centers (2-4). In the evolving Minnesota community mental health program, 12 rural mental health centers serving 45 counties have been approved for State grants-in-aid. These centers serve populations ranging from approximately 116,000 to slightly less than 50,000 residents, and 10 are multicounty units serving from three to eight counties. The distance by road from a center to the farthest village within its service area ranges from 21 to 129 miles, with 47 miles the median distance. These facts illustrate a persistent problem in planning for outpatient mental health facilities: delineation of the geographic area which one center can serve adequately. While guidelines have established the size of the population best served by a full-time mental health team of psychiatrist, psychologist, and social worker, the literature reveals no s.uggestion of the optimum geographic area to be served by either the rural or the urban treatment center. Altman's study (5) of distances traveled for care from general practitioners and medical specialists in western Pennsylvania during 1950-51 offers relevant information, though psychiatric care is not among the categories of medical specialization for which the study presents specific data.. For patients who resided in eiglht counties adjacent to medium-sized metropolitan areas and who used the services of specialists, Altman showed that 59.4 percent lived within 5 miles, while only 11 percent traveled more than 40 miles for care. For the 27 countieis constituting the total studied, he showed a negative relation of 0.74 between average distance traveled and frequency with which specialists' services were obtained. Similarly, the mental health center a,t Crookston, Minn., reported for 1958-59 a negative relation of 0.79 between utiliza,tion and distance. This statistic, like Altman's, does not take into a,ccount those persons who failed to obtain services because of the distances involved.

Mental hygiene clinics of the Veterans Administration: study of functionings, trends and effectiveness.

In July, 1951, the Committee on Veterans Affairs of the American Psychiatric Association initiated a study of the mental hygiene clinics of the Veterans Administration. The purposes were to describe and publicize this large group of clinics, to appraise their effectiveness in rendering service to the psychiatrically disabled veteran, and to utilize the data for discussion of the trends within this group of clinics and, because of their large number and distribution in this country, for a commentary on modern American psychiatric outpatient care. There are four types of clinics represented: (1) a regional clinic, which operates from the regional branch office of the Veterans Administration and which provides psychiatric service to 51 areas demarcated in this country by the VA for organizational and administrative purposes; (2) a hospital clinic, which operates in the outpatient department of a veterans hospital, usually a neuropsychiatric specialty hospital; (3) a traveling clinic; and