Public Psychiatric Institutions Research Articles

Australia's National Mental Health Strategy and Deinstitutionalization: Some Empirical Results

To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland. Regression analysis (using the maximum likelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953-54 to the present, although data are presented from 1883-84. These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953-54 to 1973-74, followed by the period 1974-75 to 1984-85. In large part, the two policies associated with deinstitutionalization, namely a discharge policy ('opening the back door') and an admission policy ('closing the front door') had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at a much slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.

Geistig-energetisches Heilen an einem öffentlichen psychiatrischen Dienst

Spiritual Healing at a Public Psychiatric Institution Introduction: Complementary medicine has an increasing importance also in Switzerland, above all for somatic diseases. The spreading of these methods in psychiatry and psychotherapy is a far slower process. The psychiatric outpatient service of the Swiss region Baselland offered, besides conventional psychotherapy and several different complementary methods, the possibility of spiritual healing and evaluated it by scientific means. Questions:Is a cooperation between a spiritual healer and a public institution feasible? What are the results of the treatment? How ist the perception of the treatment by the patients? Is further research promising? Method:Patients with diverse and mostly long-term diseases willing to receive spiritual healing had, in addition to a conventional psychotherapy, been treated by a healer working in our facilities. Before and after the healing sequence as well as at the follow-up after 6 months the patients have been questioned by means of semistructured interviews to give their impression of the treatment and its results. The respective psychotherapists and the healer herself had to give their assessment of the treatment and its results as well. Results:The analysis of the data of the first 20 patients resulted in 9 persons stating a better well-being, one a deterioration and 8 broke off the treatment prematurely in unchanged health condition. The majority of patients very much appreciated the treatment in terms of ease and relaxation, only one patient reacted with anxiety and interrupted the first treatment. At the follow-up after 6 months there has been no change to the initial results. Two persons could not be reached for the post-evaluation. Discussion:Cooperation of a healer and a public psychiatric institution proved to be feasible and fruitful. For almost half of the patients, the treatment has been a remedy highly appreciated and only one patient has reacted negatively. Therefore it seems justifiable to further offer this type of treatment and to evaluate it. To back up this estimation further, also controlled research studies should be carried out with e. g. more homogeneous patient groups or with different healers.

Special Article: One Resident's Perspective on a Different Style of Psychopharmacological Practice

This article provides a comparison of psychopharmacological practices in the U.S. and France. The prescription as well as proscription of various classes of psychotropic drugs are considered. Even though the general guidelines of psychopharmacological practice remain the same, the details vary considerably and are determined especially by commercial factors. INTRODUCTION Though a comparison of current clinical psychopharmacological practices in France and the U.S. is an unaddressed topic, these contrasts may be quite striking to an American-trained psychiatrist. The following observations are based on my two month inpatient experience as a fourth-year psychiatric resident at a public psychiatric institution located in Montpellier, France (1987). This article was written in collaboration with Dr. Blayac who is one of the regional center directors for the French equivalent of the FDA.

Urban Psychiatric Commitments: Disability and Dangerous Behavior of Black and White Recent Admissions

Nationally black patients are overrepresented in public psychiatric institutions and are more likely than white patients to be committed involuntarily. This study of patients from 12 treatment units in the Chicago area, where these patterns were also true, compared the functioning of 227 acute admissions grouped by race (white or black) and admission status (voluntary or involuntary). Patients were assessed by highly trained independent observers using objective measures of dangerous behavior and disability levels, the relevant classes of functioning based on common principles underlying commitment statutes. No evidence was found that racial bias and discrimination in commitment and retention decisions would account for the overrepresentation of blacks among involuntary commitments to public institutions. Rather, the same factors that account for the overrepresentation of blacks compared with whites among all admissions may also explain their overrepresentation among the involuntarily confined. Changes in treatment programming and assessment practices are suggested.

Resisting Reform

In the Sala de Nove of the Palazzo Pubblico in Siena, Italy, is a marvelous series of frescoes by Ambrogio Lorenzetti entitled The Effects of Good Government and Bad Government. These 14th-century masterpieces were commissioned by the city Guelf leaders to celebrate its political credo that justice and the subordination of private interests to the common good cause all human social activities to flourish. Good Government, painted in the well-lit section of the room, expresses the delights of city and country life when administered by a good government; Bad Government, appropriately painted on the dark side of the room, reveals a city of violence and crumbling buildings, and a sinister and desolate countryside. Lorenzetti' s images are a physical portrayal of human social ideals (or lack of them) in much the same way as are Jerry Cooke's American photographs of psychiatric asylums in the 1940s [1] and Carla Cerati 's photographs of Italian asylums in the 1960s [2] . Photographs of today's ex-mental-hospital patients on the streets of American cities would certainly complement this series. If Cooke's and Cerati's images reveal the effects of bad psychiatry, what, then, are the images of good psychiatry? Why have the great advances in medicine and related sciences not provided much useful knowledge for transforming societies' public psychiatric institutions? What factors have caused both mental health professionals and policy planners in the United States and abroad to abandon their interest in the reformist goals and practices that have dominated Western psychiatry over the past 25 years? Without a doubt, the American community mental health center (CMHC) movement is under political attack despite its many remark-

MEASURE EMPLOYEE INFLUENCE IN RESIDENTIAL INSTITUTIONS

The centralization of influence in residential mental health institutions is an important variable to those who wish to study the impact of organizational structure on various performance outcomes. The control graph method developed by Tannenbaum and his associates has been the most popular approach to the measurement of perceived influence distribution in organization. The authors discuss the benefits and weakness of this approach as the basis for the development of a new measurement instrument, the Employee Influence Scale. The E.I.S. was tested in four wards of a public psychiatric receiving hospital, modified, and then retested with 297 staff members in 22 wards of three long-term public psychiatric residential institutions. Findings strongly support the usefulness of this approach to measuring centralization, thus providing a new instrument for use in further research on this important aspect of service delivery.

Corroboration of the utility of the Satz-Mogel abbreviated WAIS with hospitalized geriatric patients.

The equivalency of standard and Satz-Mogel WAIS scales for psychiatrically hospitalized geriatric patients was explored further in a followup study using a repeated measures design. The two WAIS forms were found to be closely equivalent in test-retest reliability and to have highly similar means and standard deviations. Strong support was given to the authors' prevous conclusion that the Satz-Mogel short form of the WAIS may be used interchangeably with the standard WAIS in the clinical assessment of geriatric subjects hospitalized in public psychiatric institutions.

Overcoming the Mistakes of the Past

#{149}If politics is a game, then we in the community mentat health field have played very poorly. The score is now against us, and I fear the game will soon be over. Our game plan has been defensive in nature with constant bickering among our own players. The result has been loss of funding for training, for research, and for clinical services, a decline in consumer support, and a gradual return to a system of diminished services. A decade ago we were buoyed by a great surge of enthusiasm for the community mental health movement. We spoke in glowing terms of treating clients in the community, care for those not treated previously, primary prevention, consumer involvement, continuity of care, comprehensiveness of services, use of shortterm intensive care, and the use of new professionals on the therapeutic team. We talked of forging a grand coalition of consumers as a political force in the service of mental health. We spoke of cooperative efforts between private and public psychiatric institutions and the new community agencies in the areas of training, research, and clinical services. There was the vision of cooperation between all the professionals and the new professionals. There was the anticipation that federal support would continue indefinitely for training and operations. We thought that such a worthwhile movement would continue to receive escalated support from state and local sources. It was anticipated that private foundations would open their coffers for training, research, and clinical innovation. General revenue and special revenue sources were to be a financial bonanza. What went wrong, and why, and what are the keys to survival? The first great political failure was the inability to mobilize the consumers and potential consumers of service and the large mass of concerned citizens into a major political force. Possibly the reason for the failure was that we were novices at political persuasion. The psychiatrist, the psychologist, the psychiatric nurse, and the social worker were in an unknown wilderness, the normal habitat of the professional politician, the lawyer, the urban and the social planner. In addition, those in the mental health movement were too involved in other areas of program planning for this new adventure in mental health services. In the early years there was constant bickering between the providers and consumers of services over such issues as the role of community boards, staffing