State Mental Hospital Research Articles

Psychosocial approaches to violence and aggression: contextually anchored and trauma-informed interventions.

Psychosocial interventions are part of the complex understanding and treatment of violent behavior in our state mental health hospitals. A comprehensive assessment of violence and aggression includes attention to all 3 domains of prevention and assessment (primary-institutional, secondary-structural, and tertiary-direct). Trauma experiences and their consequences may include behavioral violence and aggression. The authors' premise is that trauma is a universal component in the individual assessment of violent behavior. Therapeutic interventions must include a trauma-informed formulation to be effective. Organizational commitment to trauma-informed, person-centered, recovery-oriented (TPR) care is crucial to the efficacy of any of the interventions discussed. Thus, the dynamic nature of the individual, interpersonal, environmental, and cultural factors associated with the daily operations of the inpatient unit need to be assessed through the lens of primary and secondary violence prevention, building on the recognition that the majority of persons served and staff have significant trauma histories. Once a compassionate, respectful, empathic, and empowering approach is embraced by leadership and staff, the work with individuals can proceed more effectively. Interventions used include a variety of cognitive-behavioral, interpersonal, and somatosensory therapies. These interventions, when effectively applied, result in more self-esteem, self-mastery, self-control for the person served, and diminished behavioral violence.

Malformed: Forgotten Brains of the Texas State Mental Hospital

Malformed: Forgotten Brains of the Texas State Mental Hospital is an intriguing book. It is a publication that on first glance may seem repetitive, yet there is an element instantly engaging to the...

Effect of Group Art Intervention On Clinical Symptoms and Cognitive Functions in Female Patients with Schizophrenia

Introduction Schizophrenia can impair functioning and have serious individual and societal impact. Non-adherence rate to anti-psychotics is high due to side effects, raising the importance of adjuvant therapy. Artistic creation can help the patients expressing their illness experience and finding some order in their chaotic psychotic world. Aim To determine the differential effects of group art therapy on clinical symptoms and cognitive functions. Methods Patients 7 female patients symptomatically stable, non-substance abusing with chronic schizophrenia admitted into Mamoura Mental State Hospital in Alexandria, IQ level was determined by the Digit Span Test of Wechsler Adult Intelligence scale (WAIS) with the mean of IQ found = 89. Intervention - Techniques taken from both art therapy and art expression provided as 24 group therapy sessions (2 sessions per week). Outcome measures - Symptoms severity measured by the Positive and Negative Symptom Scale (PANSS) - Executive functions and set shifting measured by Wisconsin card sorting test (WCST) - Visual attention and task switching measured by the Trail making test Results - Post treatment results showed significant decrease in PANSS sub-scales (positive p - Also significant increase in cognitive biases in WCST (number of categories) p Conclusion Symptom severity and cognitive functions in stable schizophrenia can improve when art expression and therapy are provided.

Forgotten bodies too?

Malformed: Forgotten brains of the Texas State Mental Hospital (2014) is a visually gripping, intellectually engaging and disturbing book. Stunning photographs and captions by Adam Voorhes and text by Alex Hannaford record an—until now—obscure collection of ∼100 brains that were harvested from patients of the Austin State Hospital (known as the Texas State Lunatic Asylum until 1925) and preserved in jars of formalin. The brains were collected from 1952 to 1983 by pathologist Dr Coleman de Chenar, and were gifted to the University of Texas at Austin within 2 years of his death in 1985. Some jars hold multiple brains or pieces of many brains, and a few contain additional organs. The book is lavishly illustrated with photographs of brains in unconventional orientations or floating in jars, sections of brains, and labels that are affixed to jars to indicate the disease or condition associated with their contents (Fig. 1A). These include: Alzheimer’s disease; haemorrhage; meningitis/encephalitis; various kinds of scleroses; cortical atrophy; lissencephaly; macrencephaly; macrogyria; micrencephaly; oedema; Down’s syndrome; cysts; hydrocephaly; and severe developmental anomaly. Some specimens are so malformed that it is difficult to identify their specific parts (Fig. 1B). MALFORMED: FORGOTTEN BRAINS OF THE TEXAS STATE MENTAL HOSPITAL Adam Voorhes and Alex Hannaford 2014. Brooklyn: Powerhouse books Price: US$39.95/£28.99 ISBN: 978-1-57687-708-1 Figure 1 Forgotten brains. ( A ) Most jars had red dots or red and green dots affixed to them, but without medical records the authors could not determine their meaning. (The reviewer suspects the dots might be related to periodic topping off of fluid in the jars); ( B ) this mysterious half section of brain sat alone, misshapen and unexplained. The book contains four sections: Discovery, History, The Collection and The Future. The authors begin by discussing their discovery of the rare assembly of brains that had been languishing ‘in …

Providing neurologic care in criminal systems and state mental hospitals.

As health care laws and payment structures change in the near future, neurologists may pursue other practice settings in which to provide care as a way to diversify their practice. Here we describe the challenges and opportunities involved with working in correctional and state mental hospital systems compared to a typical private practice: logistical challenges, patient and provider safety, patient characteristics, and cultural differences. Neurologists may take these factors into consideration when choosing whether to add this health care setting to their current practice.

Do Crisis Intervention Teams Reduce Arrests and Improve Officer Safety? A Systematic Review and Meta-Analysis

Until the 1950s, state mental health hospitals accommodated the majority of individuals suffering from mental illness. Today, however, following the closing of state mental hospitals, persons with serious mental illness without adequate private care are 3 times more likely to be housed in a jail or prison than in a hospital. The consequences associated with increased contact between the criminal justice system and the mentally ill necessitates a comprehensive strategy that targets improvement in interaction between the criminal justice system and the mentally ill. This article reports on findings of a systematic review and meta-analysis of the Crisis Intervention Team (CIT), a widely adopted program implemented in police departments, in an effort to reduce reliance on incarceration as mental health institutions, and to train officers about mental illness. The findings of this review and meta-analysis reveal null effects of CITs on arrests of persons with mental illness ( d = 0.180, p = .495) and on police officer safety ( d = −0.301, p = .191). These results do not suggest that CIT programs should be discontinued. However, potential improvements to program implementation and evaluation are discussed.

Modern Community Mental Health

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Today, the popular byword in community mental health is integration. Bringing outpatient mental health services into the mainstream of primary care, bringing primary care services to the seriously and persistently mentally ill, putting together mental health and substance abuse treatments for individuals with cooccurring disorders, establishing psychiatrists as the "principal physician" for their patients (including basic primary care services), and treating individuals in comprehensive settings with easy access to specialty medical services in addition to their psychiatric care are all aspects of this integration moment and movement. Yet, as Modern Community Mental Health: An Interdisciplinary Approach, edited by Yeager and colleagues, demonstrates, there is substantial specialty expertise in the delivery of community mental health services to individuals with serious and persistent mental illness who, in an era not so long ago, would have been treated in the institution—the state or county mental hospital.

Against the “Prison/Psychiatric State”: Anti-violence Feminisms and the Politics of Confinement in the 1970s

The article examines the grassroots organizing efforts of the Coalition to Stop Institutional Violence, a broad-based alliance of prisoners’ rights, mental patients’ rights, and feminist groups in Greater Boston that opposed the expansion and medicalization of maximum-security units for women in Massachusetts’s prisons and state mental hospitals in the 1970s. The case of the coalition, it argues, illustrates how grassroots feminist opposition to incarceration produced an epistemology of “violence against women” that complicated and contested liberal feminist demands for more aggressive criminalization and law enforcement of sexual and domestic violence during this period. The coalition forged an understanding of institutional violence that linked the politics of mental health to the repressive punishment of women prisoners’ agency, and the expansion of medicalized incarceration to hierarchies of race, gender, class, and sexuality. The article explores how activists’ critique of what they termed the “prison/ psychiatric state” engendered alternative conceptions of health, safety, and justice that, in turn, suggest the need for a more capacious understanding of opposition to gendered violence in the feminist 1970s.

The Old and the New Eastern State Hospital in Lexington, Kentucky

Back to table of contents Previous article Next article PerspectivesFull AccessThe Old and the New Eastern State Hospital in Lexington, KentuckyJose de Leon, M.D., Shane Shoemaker, M.L.S., and Allen Brenzel, M.D., M.B.A.Jose de LeonSearch for more papers by this author, M.D., Shane ShoemakerSearch for more papers by this author, M.L.S., and Allen BrenzelSearch for more papers by this author, M.D., M.B.A.Published Online:1 Feb 2014https://doi.org/10.1176/appi.ajp.2013.13070959AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In 1766, the first U.S. public psychiatric hospital, Eastern State Hospital, was opened in Williamsburg, Va. Another Eastern State Hospital, shown above, has continuously functioned in Lexington, Ky., since 1824. After nearly two centuries, a new state-of-the-art, patient-centered hospital opened on Sept. 10, 2013.In the late 1700s, Kentuckians who developed severe mental illness were sent to Williamsburg. In 1816, a group of public-spirited citizens in Lexington planned a hospital for the poor, disabled, and “lunatic” members of society. In 1822, the General Assembly of the Commonwealth of Kentucky passed the “Act to Establish a Lunatic Asylum.” Ten acres of land, along with the unfinished hospital building, were purchased, and thus the second-oldest state mental hospital in the United States was established (1). After the opening in 1824, the name changed several times but became “Eastern State Hospital” in 1912.Lexington’s Eastern State Hospital included a 400-acre farm and was an isolated institution, separate from the surrounding community. Many employees lived on the grounds in cottages, dormitories, separate rooms in the main hospital building, or wards with the residents. The hospital residents and staff grew and prepared most of the food consumed. A dedicated train station provided the remaining food, supplies, and coal for the on-site boilers. In 1956, over 300 acres of the farm were sold to IBM and later became Lexmark. As late as 1967, the hospital had 1,000 patients in residence. In the 1990s, the few remaining long-term patients were progressively discharged and the hospital became solely an acute-care psychiatric hospital, with 1,600–2,000 admissions per year from a catchment area in central and northern Kentucky. In 1995, the state asked the Bluegrass Regional Mental Health/Mental Retardation Board, which was operating community mental health centers, to run the hospital as well.Lexington’s third century of public psychiatric care has begun in a scenic new location less than a mile from the original location. A land swap was proposed in 2008 that included the state, Bluegrass Community and Technical College, and the University of Kentucky. The old Eastern State Hospital grounds, including the administration building, are being transferred to Bluegrass Community and Technical College. The main administrative building and a laundry building will be preserved. The University of Kentucky provided the 30-acre site on which the new hospital was built.From Eastern State Hospital, Lexington, Ky.Address correspondence to Dr. de Leon ([email protected]edu).The picture of the old hospital is from History of Kentucky (1), and the picture of the new hospital is from Mr. Shoemaker’s archive. The authors thank Lorraine Maw, M.A., and Margaret T. Susce, R.N., M.L.T., for editorial assistance.Reference1 Collins L: History of Kentucky, vol II. Frankfort, Ky, Kentucky Historical Society, 1966Google Scholar FiguresReferencesCited byDetailsCited byPotentiation of the Effect of Buprenorphine/Naloxone With Gabapentin or QuetiapineRoy R. Reeves, D.O., Ph.D., and Mark E. Ladner, M.D.1 June 2014 | American Journal of Psychiatry, Vol. 171, No. 6The Second-Oldest State Psychiatric Hospital in the United StatesDavid A. Gorelick, M.D., Ph.D.1 June 2014 | American Journal of Psychiatry, Vol. 171, No. 6Response to GorelickJose de Leon, M.D.1 June 2014 | American Journal of Psychiatry, Vol. 171, No. 6 Volume 171Issue 2 February 2014Pages 149-150 Metrics PDF download History Accepted 1 August 2013 Published online 1 February 2014 Published in print 1 February 2014

EPA-0394 – Mental health service for children and adolescents with self-destructive behavior in psychiatric hospital in metropolis

The problem of adolescent suicide is becoming essential both in urban areas and in the countryside. Outpatient and inpatient service of treatment and preventive measures supported by healthcare system and relevant authority instructions need to be created. All cases of self-destructive behavior in the biggest state mental hospital of Moscow in 2012 have been analyzed and classified. Gender, age, variants of suicidal behavior, social and family status of patients, clinical peculiarities of comorbid conditions, methods of treatment and rehabilitation have been studied. 36% of urgently hospitalized patients have revealed suicidal behavior. Self-destructive behavior was associated with affective instability, histrionic personality traits, egocentric and asocial behavior. Most part of the patients had also different psychosocial problems. Depressive disorders have been revealed in 28% people with suicidal behavior. Due to the multiplicity of predisposing factors of self-destructive behavior the diagnostic system of suicidal risk has to be modernized based on specific features of adolescents. Medical and legal standards of mental health care for these patients including civil commitment should be more precise. The terms, ways and methods of medical assistance and rehabilitation of patients in post-suicide period have to be improved.

Allen Ginsberg’s Kind of Psychiatrist

Allen Ginsberg’s Kind of Psychiatrist

Going to Texas

[ILLUSTRATION OMITTED] In 1946, a year after World War II was over and just before school started, my ten-year-old brother and I (twelve then), and my father and his new wife--all of us nearly strangers to each other--piled in her bulky green Buick and drove west from Nashville. We were on our way to a small town in central Texas called Gatesville. Crossing the Mississippi River, putting my head out of the window to stare at its broad muddy width--the last boundary of my well-known southern world--I left Tennessee. Of all the journeys I've made, the trip that made the greatest difference to my life was the one that took us to Texas in that sliver of time between the atomic end of World War II and the beginning of the Korean War. Like many others when the long-awaited peace arrived, my life was completely rearranged. The only Texan in the car was our new mother, Mabel Winters Culbert. Married earlier that month, she'd been introduced to my father by mutual friends when he was stationed at Ft. Hood just outside of Gatesville. My brother Billy and I had already gone through a great deal of change. He'd spent the past three years with relatives in Pennsylvania, while two aunts and an invalid grandmother in Nashville had taken me in. Luckily, we belonged to an extended family, one whose bonds still held. Our mother, hospitalized in 1943, was diagnosed as incurably ill with schizophrenia. Following medical trends in the Forties, her doctors ruled it would not help the patient or her children to see each other. So no matter how often we begged to visit, we were not allowed. Our father, our grandmother, our aunts and uncles could see her at Tennessee's Central State Mental Hospital on the outskirts of Nashville; we were forbidden. To avoid passing on the stigma of mental illness in the family, all of the adults apparently agreed we would be best protected by silence. This secrecy permeated our lives. As little was explained, we understood little. Not until I was grown would I see my mother again. Neither my brother nor I had witnessed any manifestation of her illness. She was taken away after she attempted suicide--a fact we didn't know until we were adults. We were at a birthday party; when we came home, she'd disappeared. For me, her schizophrenia meant grief--a slow trickling kind of grief when I suspected she might not get well, followed by tears and more grief when told she could not. In late May of 1946, I rode to Pennsylvania to reclaim Billy with our father, a colonel in the field artillery, released at last from the army but still active in the reserve. Except for two brief visits, we had lived as only children for three years; now together again, we hardly knew what to say to each other. I was deposited in Nashville with my aunts and grandmother once more while my brother was allowed to go with our father to Lake Mead, Nevada, a place where they could both fish and get to know each other again. To my father, being outdoors was both a pleasure and a comfort. He found the natural world a consolation, and he intended to pass that comfort on to his son. After living in Nevada for six weeks, he obtained a divorce--at that time, insanity wasn't one of the legal causes for divorce in Tennessee. When I think of my father's shuttling us all over the country that summer in his little black used La Salle coupe, I realize it was his desire to put his family back together that drove him. I'm not certain how other people who've known sorrow start again; however, a vague hope about the future must have been a part of my own daily wonder at the turns our lives were taking. A few days before leaving Nashville, my father and my new stepmother arrived in her Buick. What should I call her? I questioned my aunts when she'd gone upstairs. My brother had the same problem, though he wasn't saying anything about it. Go and ask her, they said. I ran immediately to my father's childhood bedroom where she was sitting at the dressing table after taking off her hat--red felt shaped like an upturned bucket with a bow around it. …

Health Care for the Homeless: What We Have Learned in the Past 30 Years and What’s Next

In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care.

Covert Treatment of Violent Patients

Mr. T is a 28-year-old Singaporean with a longstanding history of schizophrenia characterised by prominent paranoid delusions and command auditory hallucinations. He struggled academically in school and had difficulties making friends, but reported no significant behavioural problems. Like all young Singaporean males, Mr. T enlisted into the compulsory National Service at the age of 18. A month into his basic military training, he started believing that his platoon commander was part of a conspiracy to kill him. Mr. T was referred to the state mental hospital by the medical officer. In the hospital, he revealed to the attending psychiatrist that he was part of a secret intelligence organisation and that he could hear the enemies conspiring to take control of his mind and kill him. Antipsychotic medication was started with subsequent resolution of the psychotic symptoms. He was discharged from the army and was eventually able to secure employment with a family friend at the local fish market. There, he met his wife-to-be. He told her that he had previously been admitted to the state mental hospital but she felt that she could help him. They married and moved into a one-bedroom flat. 18 months later, he was brought back to the hospital by police after threatening his wife with a knife, believing that she was part of a conspiracy that was monitoring him. It was revealed that he had stopped seeing his psychiatrist and had discontinued his medication for more than three months as he did not think that there was anything wrong with him. Antipsychotic medication was started and psycho-education was also given to him and his wife. The delusion resolved and he was discharged. Over the four years, Mr. T was re-admitted to the hospital on another four occasions following an exacerbation of his illness after he stopped his medication on his own accord. Each time, he was brought in by the police following reports of domestic violence where he would threaten his wife with a knife and accuse her of being an enemy agent trying to control his mind. After being released, his symptoms would resolve but he continues to lack any awareness that he has an illness and, after awhile, refuses to take his medication and see his psychiatrist. He has also vehemently refused any depot antipsychotics. He has recently been discharged from the hospital and has again refused to take his medication. Mrs. T is terrified that he will become unwell again and has come to see the psychiatrist at the clinic. She wants to collect Mr. T’s medication and tells the psychiatrist that she intends to give them to him covertly in his food.

Change, Challenge and Opportunity: Psychiatry in Age of Reform and Enlightenment

Change, Challenge and Opportunity: Psychiatry in Age of Reform and Enlightenment

The origins of molecular psychiatry.

The origins of molecular psychiatry.

2040 – Clinical characteristics of patients with schizophrenia associated with drug and alcohol dependence

Objective To analyze social, demographic and clinical characteristics of patients with schizophrenia and comorbidity drug dependence. Methods Clinical interview with specially elaborated formalized card. Patients were diagnosed according to ICD-10 criteria. 182 patients were treated in St Petersburg state mental hospital № 3 in 2005-2010. Results Alcohol, cannabis, and heroin tend to be the primary substances of abuse. According to the drug usage we form two groups. The first group (n = 105, 57,7%) consisted of patients who abuse alcohol only. The second group consisted of patients who use different types of drugs (n = 77, 42,3%). Both groups had high rates of unemployment, disability, length of stay in a psychiatric hospital. Schizophrenia patients with multidrug dependence (2 nd group) were younger than patients with alcohol dependence only (1 st group). Middle age of patients of 2 nd group was 31, 38 ± 0, 94 and middle age of patients of 1 st group was 42, 45 ± 1,14. Patients of both group were unemployed 92 (87, 61%) and 62 (80,52%) respectively. We identified statistically significant between-group differences in patients with paranoid schizophrenia. Patients of 1 st group had paranoid schizophrenia higher 76 (72, 38%) than patients of 2 nd group 39 (50, 65%). On the contrary, simple schizophrenia was diagnosed more often in patients of 2 nd group 29, 87% and 14, 28% respectively. Drug dependence disorders come before schizophrenia manifestation significantly more often (51,95%) than alcohol use disorders (AUD) (31,43%). AUD occurred after schizophrenia manifestation (33, 33%) significantly more often than drug dependence disorders (12,9%).

Last Resort of Individuals with Dementia Threatened

A recent Wisconsin Supreme Court decision held that individuals with dementia cannot be placed involuntarily into “units for the acutely mentally ill.”1 This creates a treatment vacuum for people with dementia who develop behavioral disturbances too severe to be managed elsewhere. Ironically, one premise for the court's decision was that, under Wisconsin law, civil commitment required amenability to “treatment,” which was defined as “rehabilitation.” The court ruled that because individuals with dementia cannot be rehabilitated, they cannot be civilly committed. Can individuals with psychiatric or behavioral disturbances caused by dementia be cured? No. Can they be treated? Most certainly yes. In spite of recent data on the dangers and limitations of pharmacological therapies for behavioral disturbances due to dementia, there is much (including a safe environment and nonpharmacological therapy) that inpatient psychiatric facilities can offer to individuals with dementia.2-5 Many people experience improvement or resolution of their symptoms.4, 5 In Wisconsin, a fundamental misunderstanding about the care of individuals with dementia has resulted in the exclusion of individuals with dementia from the civil commitment process. That process is an unpleasant but necessary step on the path to stabilization for many people with psychiatric or behavioral symptoms of dementia. It is our hope that the misunderstanding in Wisconsin will be quickly corrected. Perhaps even more important, we hope that Wisconsin's mistake does not spread to other states. California and Florida are the two states with the greatest number of people aged 65 and older. There is a real possibility that both could follow Wisconsin. California's attorney general has concluded that individuals with Alzheimer's disease may be held for 72 hours in the first step toward civil commitment,6 but further detention must be for treatment.7 A California court could, as in Wisconsin, conclude that treatment is not possible for dementia. Indeed, one California court upheld a conservator's determination that an individual's “inability to care for himself [was] not a product of a mental disorder for which treatment [was] available in a state mental hospital, but a result of dementia.”8 The definition of “mental illness” in Florida is broad enough to include dementia and even specifies that etiology is irrelevant.9 The Florida Supreme Court has held that a person who is involuntarily committed has a right to treatment.10 Florida statutes codify and broaden this right to include “such medical, vocational, social, educational, and rehabilitative services as his or her condition requires in order to live successfully in the community.”9 This broad definition of treatment may appear encouraging, but a court could conclude that civil commitment is inappropriate for individuals with advanced dementia who will never be able “to live successfully in the community.” Success in treating individuals with dementia, as with other mental illnesses, often means modest and sometimes temporary improvement in symptoms. To twist that unfortunate reality into a reason to deny supportive care in what may be the best setting is a legal blunder of colossal proportions. We must educate policy-makers to reverse the Wisconsin error and to prevent its spread. Conflict of Interest: Neither author has any conflict of interest. Author Contributions: Fredrick Vars provided legal analysis. Caroline Harada provided medical expertise. Both contributed significantly to the drafting. Sponsor's Role: No sponsor.

Mental health law in Finland

A tradition of Romano-Germanic or civil law defines the legal system in Finland. Laws of relevance to psychiatry are the 1990 Mental Health Act and, insofar as it pertains to forensic psychiatry, the Criminal Law (1889) and the Law on State Mental Hospitals (1987, revised 1997). These are outlined in the present paper.

Broad-based with a cutting edge: The evolution and growth of NIMHANS

The National Institute of Mental Health and Neuro-Sciences (NIMHANS) in Bangalore, India began as the lunatic asylum, in 1848, when a separate asylum to care for the mentally ill was approved by Sir Mark Cubbon, Commissioner of Mysore in the Pettah area of Bangalore. After the transfer of power from the British to the Kingdom of Mysore in 1881, it became, for a while, the only asylum to be supported by a native kingdom. A larger mental hospital, in the light of the expanding population of Mysore, was thought essential by the 1920's, when the Maharaja of Mysore approved the decision to build a new asylum. This was finally completed in 1937, and by then had been renamed as the Mysore State Mental Hospital. The hospital, and its staff, was recommended as the first institution to begin training specialists in psychiatry and related mental health fields, after Independence, in 1953, when it was renamed the All-India Institute of Mental Health. It now houses the Department of Psychiatry at NIMHANS. The asylum architecture, horticultural layout, high standards of mental health care and emphasis on scientific training initiated in the early part of the last century continue to date and many of its alumni hold distinguished positions all over the world.