State Mental Hospital Patients Research Articles

Rehabilitation of long-stay patients in state mental hospitals: Role for social welfare sector

Barriers to discharge long-stay patients with mental illness (PWMI) are complex and involve social factors. Recent legislations emphasize community living and creation of facilities by Government for PWMI without social support. The Honorable Supreme Court has dealt with the need for setting up rehabilitation homes for long-stay PWMI who do not require hospitalization. In such cases, nominated representative from social welfare sector needs to be involved in discharge planning. The social welfare sector needs to play a bigger role in the rehabilitation of long-stay PWMI.

Mental Health Counseling and Specialty Courts

In 1963, the passage of the Community Mental Health Centers Act (Feldman, 2003) led to the closing of most state psychiatric hospitals and the provision for providing services at the community level. However, the same act had the unintentional result of transferring patients with severe mental illness from psychiatric hospitals into jails and prisons (Farmer et al., 2017; Hnatow, 2015; Shenson, Dubler, & Michaels, 1990; Torrey et al., 2014). More recently, the war on drugs has exacerbated the problem of overcrowding in penal and justice systems ill-equipped to provide therapeutic services for these individuals (Hafemeister & George, 2012; Harvard Law Review, 1998; Torrey, 1997; Walsh & Holt, 1999). This predicament has led to the Cook County jail in Illinois being labeled as the country's largest mental health institution (Hill, 2016).In order to facilitate greater efficiency and effectiveness in the justice system for the populations encountered, specialty courts act to counter a system that historically has depersonalized individuals (Kleinfeld, 2016). Specialty courts identify common issues faced by particular populations and address the underlying causes of criminogenic behavior by focusing on the individual to produce better outcomes. Although mental health professionals fulfill pivotal roles in these courts, many counselors are unfamiliar with specialty courts. The purpose of this paper is to describe the specialty court movement and the roles of counselors within it.The Justice System-Old and NewThe justice system in America has traditionally been one of punitive action-to punish offenders and deter the tempted. Since the 1950s, America's policies targeting illicit drug use have resulted in a large population of low-level offenders serving long, mandatory-minimum sentences, often with inadequate support and resulting in repeated contact with the traditional criminal justice system (Haley, 2016; Kupers, 2015).Between 1968 and 1978, the number of patients in state mental hospitals fell 64%, while the census in state prisons rose 65% (Steadman, Monahan, Duffee, & Hartstone, 1984). In 2012, the number of prisoners diagnosed with mental illness exceeded 352,000, more than 10 times the number in state psychiatric hospitals (Torrey et al., 2014). In the absence of evidence that incarceration without treatment is in their own best interest, or that of society (Isaac & Armat, 1990; Kondrat, Rowe, & Sosinski, 2012), such prisoners are a burden on the limited resources of prison systems in every state.The specialty court movement arose to address the specific needs of the mentally ill, drug offenders, and other populations, and to effect a decrease in the underlying causes of criminal behavior and thereby reduce the number of people incarcerated in jails and prisons. Specialty courts take the traditionally adversarial roles of prosecution and defense and turn them into cooperative roles to foster a therapeutic environment for those individuals who would benefit (Kondo, 2001). Veterans treatment courts are a more recent addition to the specialty court movement, joining mental health courts, drug courts, gun courts, domestic violence courts, and other specialized courts (Baldwin, 2016). Veterans treatment courts treat underlying causes of crime and other challenges faced by veterans and service members.The Center for Court Innovation developed three organizing principles for specialty courts (Boldt, 2014). The first principle is a problem-solving orientation that identifies and addresses underlying causes of criminality common to specific groups; the second principle is cooperation with community resources offering treatment and oversight; and the third principle is accountability (Boldt, 2014). These principles work within the context of the two major approaches of specialty courts: therapeutic jurisprudence and restorative justice.Two Working Approaches in Specialty CourtsThe specialty court movement is based on two overarching approaches: therapeutic jurisprudence, which seeks improved outcomes for the individual facing charges; and restorative justice, which seeks restitution for all stakeholders. …

Prison MH Care Ruling Could Push Salaries Higher

Prison MH Care Ruling Could Push Salaries Higher

Comparing the stigma of mental illness in a general hospital with a state mental hospital

The stigma faced by psychiatric patients associated with the type of psychiatric facilities is controversial. This study was conducted to compare the stigma faced by patients with schizophrenia and non-schizophrenia psychiatric disorders in the outpatient departments of a state mental hospital with those in a general hospital in Singapore. A cross-sectional study involving two groups of outpatients in a state mental hospital (n=300) and in a university general hospital (n=300) were assessed with a 12-item stigma scale. Components of the scale assessed included social rejection, negative media perception, shame and social discrimination. Among schizophrenia patients, state mental hospital patients had significantly lower stigma scores compared to their counterparts in the general hospital. For other mental illnesses, the reverse was true: state mental hospital patients had significantly higher stigma scores compared to their counterparts in the general hospital. Stigma was also associated with a younger age and being employed though not by gender. The stigma faced by psychiatric patients is complex and may have institutional and disorder-specific elements. Possible reasons for this are discussed.

Caring for Patients’ Graves Helps Hospitals Reconcile With Living

Caring for Patients’ Graves Helps Hospitals Reconcile With Living

Evaluation of Psychiatric Rehabilitation

The deinstitutionalization and dehospitalization processes initiated in various countries approximately twenty years ago have produced a wealth of experiences, theoretical reflections, and, at times, epidemiological data of paramount importance. Their objectives and generating principles were heterogeneous in fact, sometimes contradictory. A result has been the gradual creation, alongside the population of psychiatric patients confined in asylums, of a population, one much larger than the former in numerical terms, made up of former mental hospital patients and psychiatric patients no longer destined for institutionalization. The number of patients in state mental hospitals in the USA decreased by 80% in the 30-year period 1955-85 [1]. In Italy the inpatient population dropped from 92,000 in 1963 to 32,000 in 1984 [2]. This massive reduction in institutionalized people obviously must be read in different ways, according to the different legal, administrative, and clinical modalities that caused it. The so-called transinstitutionalization (migration of psychiatric patients from psychiatric institutions to nonpsychiatric facilities) that characterized the North American scene [3] was not so evident in the years following the Italian reform; but the phenomenon of new chronicity, i.e., the increase in the number of chronic patients who have

The Isolation of HIV- Positive Patients

To the Editor.— We read with interest the March 17 JAMA article by Dr Gostin 1 entitled Public Health Strategies for Confronting AIDS [acquired immunodeficiency syndrome] and felt a need to share with you a problem related to quarantining AIDS patients in state mental hospitals. The prevalence of human immunodeficiency virus seropositivity (enzymelinked immunosorbent assay and Western blot test positivity) among hospitalized patients in a study of sentinel hospitals throughout the country was 0.3%. 2 The prevalence of positivity among all patients tested through the South Dakota Health Department's laboratory during 1988 was 0.32% (R. Louchart, RN, personal communication, February 1989). The South Dakota Human Services Center, with a census of nearly 430 patients, is the sole general psychiatric hospital in the state. Staff physicians there did no routine testing for AIDS during 1988, but rather performed enzyme-linked immunosorbent assays on patients deemed to be at high risk. High-risk status

The state mental hospital and public psychiatry.

AbstractServices offered to chronic mental patients in state mental hospitals of the future are likely to be determined by a variety of forces external to the hospitals themselves.

Clinical and demographic characteristics of chronic inpatients: implication for treatment and research.

Clinical and demographic data were collected on 203 state mental hospital patients whose length of stay was greater than one year. They comprised 45% of the average adult census and 37% were less than 35 years old. Males were younger and females more educated and likely to have been married at one time. The majority have diagnoses of schizophrenia or organic mental disorders; a few have personality disorders. Patients were treated with drugs but risk/benefit parameters remain to be defined. Thirty-two percent of patients have had a violent episode during the past six months. The prevalence of neurological abnormalities supports the need for specialized neurological and neuropsychological consultation and medical consultation. Most patients require the level of care provided by a hospital, while 15% are ready for discharge but have no housing available. Intermediate care facilities could provide alternatives for some patients otherwise unable to leave the hospital. The implications raised by these findings are discussed.

Whither goes in/outpatient psychiatric care?

"Anyone reading newspapers in the United States knows that there are many former state mental hospital patients living and sleeping on the streets or in dilapidated hotels." With these words, Alfred M. Freedman, MD, chair of the Department of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, NY, engaged in a discourse at the recent Seventh World Congress of Psychiatry in Vienna on the pluses and minuses of the well-known shift from government (state) hospitals to general hospitals as the principal site of inpatient psychiatric care in the United States. According to Freedman, 75% of psychiatric patients received treatment in state hospitals in 1955 and occupied approximately 750,000 beds. By 1965, the number of beds had decreased to 650,000; by 1980, the number was below 200,000. Specific treatment episodes (such as a drug regimen or electroconvulsive therapy) in state hospitals represented 49% of all psychiatric treatment in

Whither goes in/outpatient psychiatric care?

"Anyone reading newspapers in the United States knows that there are many former state mental hospital patients living and sleeping on the streets or in dilapidated hotels." With these words, Alfred M. Freedman, MD, chair of the Department of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, NY, engaged in a discourse at the recent Seventh World Congress of Psychiatry in Vienna on the pluses and minuses of the well-known shift from government (state) hospitals to general hospitals as the principal site of inpatient psychiatric care in the United States. According to Freedman, 75% of psychiatric patients received treatment in state hospitals in 1955 and occupied approximately 750,000 beds. By 1965, the number of beds had decreased to 650,000; by 1980, the number was below 200,000. Specific treatment episodes (such as a drug regimen or electroconvulsive therapy) in state hospitals represented 49% of all psychiatric treatment in

Position Statement on the Separation of Children and Adolescents from Adult Patients in State Mental Hospitals

Back to table of contents Previous article Next article ArticleNo AccessPosition Statement on the Separation of Children and Adolescents from Adult Patients in State Mental HospitalsPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.138.11.1529AboutSectionsView articleAbstractPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleAbstractThis statement was approved by the Assembly of District Branches at its October 24-27, 1980, meeting and by the Board of Trustees at its December 12-13, 1980, meeting. It was prepared by the Task Force on Children and Adolescents in State Mental Hospitals of the Council of Children, Adolescents and Their Families. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 138Issue 11 November 1981Pages 1529-1529 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1981

Factors Distinguishing Urban and Rural State Mental Hospital Patients in Florida

Factors Distinguishing Urban and Rural State Mental Hospital Patients in Florida

Explaining the increased arrest rate among mental patients: a cautionary note.

The author compared the annual arrest rates through 1978 of 301 state mental hospital patients released in 1972--1975 with arrest rates of the local county (San Mateo County) population in 1978. The data do not easily allow acceptance of the explanation for the increasing arrest rate among ex-patients suggesting that a definable group with previous arrests accounts for the increase. In San Mateo County, ex-patients with no previous arrests were arrested roughly three times more often than the local county population and five times more often for serious violent crimes.

Unexpected consequences of deinstitutionalization of the mentally disabled elderly.

An unexpected consequence of the rapid deinstitutionalization of state mental hospital patients has been a sharp rise in posttransfer mortality among the elderly. Considerable evidence suggests that outcome is mediated by two factors. Elderly patients with certain characteristics - especially physical frailty and severe cognitive impairement - comprise a high-risk subgroup for whom relocation is likely to be fatal. Among other elderly persons, environmental, personality and personality-environment congruence are associated with posttransfer prognosis. The studies reviewed indicate that the therapeutic value of deinstitutionalization for mentally disabled elderly persons is problematic.

Incidence and morbidity of self-induced water intoxication in state mental hospital patients.

Incidence and morbidity of self-induced water intoxication in state mental hospital patients.

Crime and violence among mental patients reconsidered in view of the new legal relationship between the state and the mentally ill.

The author compared the arrest rates of 301 former state mental hospital patients with those of the local county population and selected U.S. cities. He found that the patients had a markedly higher incidence of arrests for criminal behavior, including violent offenses, than either of the comparison groups. Patients who were female, aged 20-30, and nonwhite had higher arrest rates for violent offenses than the rest of the study group. These findings are at variance with those of earlier studies but are in general agreement with more recent studies. The author suggests the need for further research in order to more completely identify those factors which explain the high crime rate among the mentally ill.

Chromosomes and mental status. A study of women residing in institutions for the elderly.

To examine a previously postulated relationship between chromosome loss (hypodiploidy) and mental impairment, 78 women ages 68 to 98 years (mean age 82.8) were selected from a New York State mental hospital and an institutional complex consisting of a nursing home, intermediate-care facility, and residence for the elderly. Nursing home and state mental hospital patients showed a significantly higher frequency of chromosome loss than did the more intact women in the other two settings. There was a tendency, which did not reach statistical significance, for women with moderate or severe organic brain syndrome (OBS) diagnosis to have a greater percentage of hypodiploid cells than women with mild or no OBS. Implications of these findings include the possibility that hypodiploidy rather than being purely detrimental may be an adaptation to aging.

Antiparkinson Drug Overuse

Antiparkinson Dru~s and Phenoxene in relieving akinesia. Their effectiveness in relieving these symptoms has led to the wide-spread use of antiparkinson drugs in psychiatry; a usage which we believe is greater than needed or desirable because of the manner in which they are given and not because we question their efficacy. Prescribed appropriately, we believe that present usage could be cut at least in half. In particular there are two practices that seem not to be warranted on the basis of what is presently known about these drugs: that of administering the antiparkinson drugs as a prophylactic measure, and that of continuing a patient on an antiparkinson drug for as long as the patient is on an anti-psychotic agent. With regard to using the antiparkinson drugs prophylactically, our review of the literature uncovered only 2 articles bearing specifically on this matter. In one phase of their study, Lapolla and Nash administered a phenothiazine and an anti-parkinson agent, biperidin (Akineton), concomitantly to 49 patients who had previously exhibited signs to the same phenothiazine alone. Extrapyramidal symptoms subsequently re-occurred in 12 of the 49 patients on this combined therapy. When they next took all • The use of psychotropic drugs such as the phenothiazines, thioxanthenes, and butyrophenones as effective means of treating schizophrenic patients is a common practice in psychiatry today. From 40 to 70% of all patients in state mental hospitals, at one time or another, are placed on a drug from one of these three classes of antipsychotic agents. It is well-known that frequent accompaniments of treatment with these drugs are the so called extrapyramidal side effects: symptoms such as dystonias, dyskinetic movements, parkinson-like tremors, akathisia, etc. Depending upon the particular psychotropic agent administered, the dose administered, and the ages and sex of the patient populations involved, the incidence of their occurrence has been reported to be from 4 to 50% of the

Depressive pattern, social background, and hospitalization.

All admissions to three different psychiatric inpatient facilities were screened, and patients fitting defined criteria for depression were further studied by semistructured interview, rating scales, and self-report questionnaires. The three facilities, all serving the same area, were the psychiatric ward of a general hospital, a mental health center, and a state mental hospital. Differences in the depressed patient groups admitted to the three facilities were examined. Major differences were found among the three facilities regarding social class and other related social indices. The general hospital admitted patients of highest and the state mental hospital patients of lowest social class, with the mental health center intermediate. Clinical differences were less striking but suggested a higher incidence of endogenous depression in the general hospital patients, with an even higher incidence in a group of patients subsequently studied who were admitted to a clinical research ward. The state mental hospital group showed a particularly high incidence of recurrent illnesses. These results contrast with previous findings that when outpatients and partially hospitalized patients are compared with inpatients, a continuum of degree of hospitalization can be demonstrated, in which the main distinguishing features are clinical rather than sociodemographic. The findings emphasize the heterogeneity of depression and the need for caution in generalizing from selected samples of depressives in clinical and biological research. They illustrate aspects of the sorting process within a community by which patients are admitted to different facilities, and suggest that, within a single level of hospitalization, social factors are the most important.