State Mental Hospital Research Articles

Hurricane Blows In, But So Does Opportunity

Hurricane Blows In, But So Does Opportunity

A Clinical Alternative to the Public Health Approach to Mental Illness: a forgotten social experiment

In the last half of the 20th century, the community mental health movement, based on a public health model, came to dominate patterns of care for mental patients. In the process, brutal deinstitutionalization of very ill patients took place, at least in the United States. These events were not inevitable. In 1949, the Menningers of Topeka, Kansas, began administering Topeka State Hospital, which was in deplorable condition. By concentrating expenditures on clinical personnel, the Menningers humanely deinstitutionalized many patients before chlorpromazine, before the entitlement programs of the U.S. federal government such as Medicaid (1965), and before the community psychiatry movement got under way. Topeka State Hospital furnished a model of mental health care that centered a whole system on a last-resort, large, specialized state mental hospital. This inadvertent social experiment suggests that a clinical approach to mental health care offers a hard-headed alternative to present arrangements.

Psychiatry Chief Quits After Order To Commit Offender

Psychiatry Chief Quits After Order To Commit Offender

Homeless Admissions and Immigration in a State Mental Hospital

Homeless Admissions and Immigration in a State Mental Hospital

Datapoints: State-Administered Spending on Mental Health Services by Type of Service

29 T report of the President’s New Freedom Commission on Mental Health has renewed attention to programs designed to reduce unnecessary institutionalization and promote community living. Spending for different types of care provides one important indicator of states’ support of such programs. Traditionally, the primary source of such information has been from the budgets of state mental health agencies. In fiscal year 2002 two-thirds of spending by state mental health agencies went to community mental health services, with 30 percent going to state mental hospitals (1). Increasingly though, such budget data provide only a partial picture of states’ mental health spending. For example, mental health agency data do not usually include spending by other agencies or spending for mental health services provided by nonspecialty providers. A broader picture of total spending by states on mental health services can be derived from estimates of national spending for mental health and substance abuse services (2). One feature of these estimates is the calculation of payment for mental health services by major payer categories. Two of these categories—Medicaid and other state and local government funding—make up most of the spending for mental health services that states and localities administer. The estimates show spending by type of provider, such as general hospitals, and by type of service— inpatient, outpatient, residential, or prescription drugs. This type of calculation provides a different perspective on spending, because many providers, such as hospitals, deliver multiple types of services. State-Administered Spending on Mental Health Services by Type of Service

Atropine Coma

Insulin coma and various types of convulsive therapies were the major biologic treatment modalities in psychiatry before the psychopharmacological era. Except for electroconvulsive therapy (ECT), these methods disappeared from the psychiatric armamentarium after the introduction of psychotropic drugs. Atropine coma therapy (ACT) was one variety of nonconvulsive coma therapy used from the 1950s in a few state mental hospitals in the United States and in several Middle- and Eastern European countries until the late 1970s. In ACT, a coma of 6-10 hours' duration was induced with doses of parenteral atropine sulfate that were hundreds of times greater than the therapeutic dose administered in internal medicine. Although ACT was given to thousands of patients with a variety of diagnoses for nearly 3 decades, it is rarely mentioned, even in papers on the history of psychiatry. The method, indications, contraindications and adverse effects of ACT are summarized together with patients' personal accounts. Hypotheses concerning its mode of action are briefly mentioned. The reasons why ACT never gained wider acceptance are explored in the context of both contemporary psychiatric practice and the broader sociocultural climate of the era.

Psychosurgery in Sweden 1944–1964

“The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance.” –George Kisker, 1944 in the Journal of Nervous and Mental Disease “The psychosurgery era seems to me a sad intermission [in the history of psychiatry] which preferably should be left behind in silence.” –Dr. Olof Dagberg in his last annual report, from The Psychiatric Hospital, Stockholm, 1965 This study presents results on hitherto unknown data on lobotomies performed at the former State Mental Hospital of Umedalen (from here on called simply “Umedalen”) in the north of Sweden. More than 700 operations were carried out from 1947 through 1960, and we calculated the average rate of postoperative mortality to 7.4 percent, and that 63 percent of those who were operated were women. By considering annual hospital reports to the National Board of Health (Medicinalstyrelsen), we also made the first mapping of early psychosurgery in Sweden; approximately 4,500 lobotomies were performed between 1944 and 1966. Statistical analysis, qualitative content analysis, and discourse analysis were used. The study supports earlier findings of female preponderance in the number of lobotomy operations.

Long‐Range Studies of Mental Hospital Patients: An Important Area for Research in Chronic Disease

Long‐Range Studies of Mental Hospital Patients: An Important Area for Research in Chronic Disease

Enthospitalisierungsprozesse in deutschen psychiatrischen Großkrankenhäusern

The process of discharging previously long-term hospitalized patients from German state mental hospitals, and of transferring these patients to other forms of supported housing has meanwhile come to its end. Therefore, this paper presents an overview of the scientific evaluation of this process. By using clearly defined research methodological criteria, eight empirical studies from several German federal states are assessed focusing on the meaningfulness of their results. Because of the heterogeneity of the aims regarding contents of this transformation process, of the research methodological approaches, and of the characteristics of the assessed patient groups, only few general results could be identified. Chronically mentally ill patients (mostly suffering from schizophrenic disorders) who had been successfully discharged to the community were younger, and showed shorter periods of illness and hospitalization than control patients. After discharge they might have experienced positive changes of their objective and subjective quality of life and of their perceived needs of care. Referred to several other outcome domains, no homogeneous tendencies concerning clinically relevant improvement or deterioration were found. In particular, changes related to psychopathological symptoms and social competencies were generally small. However, mortality and re-hospitalization rates of de-hospitalized patients were considerably high, and ranged between 3-24 %, and 4-46 %, respectively. The assessed studies could not identify replicated predictors of successful de-hospitalization. Female sex and long-term last hospitalization seemed to be important for stable placement in forms of supported housing requiring a higher level of autonomy. From the generally unclear procedural quality of the German deinstitutionalization process, the authors deduce implications for the scientific evaluation of future projects of restructuring mental health care services. Besides the clear definition of empirically assessable aims which should be based on theoretical considerations, it is of utmost priority to guarantee high performance quality of research methodological standards.

The Choice of Antipsychotic Drugs for Schizophrenia

Since the discovery of the effects of chlorpromazine in the 1950s, treatment of schizophrenia has relied on antipsychotic drugs that target dopamine D2 receptors. The effectiveness of these agents in reducing the intensity of patients' delusions and hallucinations permitted outpatient treatment instead of lifelong institutionalization in state mental hospitals. The many antipsychotic drugs introduced during the next decade were increasingly potent, as medicinal chemists improved the drugs' affinity for the D2 receptor. However, the efficacy of the drugs was similar, since all had the same mechanism of action.1 A troubling problem was that the blockade of dopaminergic neurotransmission in the . . .

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.

Direct-care staff body mass index in a state mental hospital: Staff obesity may impair role modeling for patients

Introduction Direct-care staff at institutions providing long-term care serve as both caretakers and role models for their patients. The authors report a second study showing that major portions of such direct-care staff have significant problems themselves with overweight and obesity. This may be another changeable factor in the complex dynamics governing overweight and obesity among patients with chronic mental illness. Method The authors recorded age, sex, and race, and measured height and weight during a typical 8-h shift among 50 direct-care staff at a long-term care psychiatric institution. Direct-care staff were defined as those members of the nursing staff who spent at least 4 h of their 8-h shift in direct contact with their patients. Results Of the 50 direct-care staff, 44 were black females. The authors focused on this subgroup in our report. These 44 black female direct-care staff had a mean body mass index (BMI) of 33.8 ± 8.3 kg/m 2 and 27 (61.4%) were obese. Six of them (13.6%) were morbidly obese. Conclusions Overweight and obesity may be a greater problem for staff providing care for patients with chronic mental illness than for the patients themselves. The authors believe studies are needed to test the hypothesis that staff obesity may impair staff ability to help obese patients lose weight. In our two studies to date, black women functioning as direct-care staff were highly vulnerable to overweight and obesity.

Legal Issues in the Treatment of a Violent Manic Patient in a Non-Gazetted Setting: A Case Report

Introduction: Psychiatrists in non-gazetted treatment settings, like psychiatric wards in restructured general hospitals and private hospitals, face a major problem when psychiatric patients who require admission are either not competent or refuse to consent to admission and treatment, although they are clearly in need of such inpatient management. Admission to the state mental hospital is often refused by their relatives for a number of reasons, like the stigma attached to admission to such a hospital, and the fear that future employment prospects might be affected. Clinical Picture: Mr X, a manic, violent patient, had no insight into his disorder and refused admission and treatment for his manic episode. He was the head of a large corporation, and his relatives were apprehensive he would make decisions that could jeopardize the company. Treatment: He refused oral medication, could not tolerate parenteral haloperidol and had lithium nephrotoxicity. Inpatient electroconvulsive therapy had to be administered, after which he responded satisfactorily. Conclusion: The legal implications in this case, like consent for treatment and admission, and ethical issues, are discussed.

NURSING CARE IN A STATE HOSPITAL BEFORE AND DURING THE INTRODUCTION OF ANTIPSYCHOTICS, 1950–1965

Oral history methods were used to describe the experiences of American nurses who practiced in a state mental hospital before and during the introduction of antipsychotic medications. The nurses described their responsibilities for supervising staff, administering patient care, and assisting with special psychiatric treatments. They expressed resignation and frustration with trying to provide care despite obstacles such as unqualified physicians, crowded wards, and inadequate personnel and supplies. The nurses adopted a Cartesian approach in which they focused on the patient's body, instead of the patient's mind, and developed camaraderie among nurses through which they found acceptance and were able to continue to do a thankless job.

Feminist Disability Studies

Feminist Disability Studies

Lawmaker's Crusade Boosts MH Funding

Back to table of contents Previous article Next article Government NewsFull AccessLawmaker's Crusade Boosts MH FundingKate MulliganKate MulliganSearch for more papers by this authorPublished Online:3 Dec 2004https://doi.org/10.1176/pn.39.23.00390007In California, a state famed for the size of its budget deficit, voters passed Proposition 63, a ballot initiative that is estimated to result in $700 million in new money for mental health services each year (see Original article: page 1).Members of the California Psychiatric Association (CPA) give a great deal of credit for that victory to Assembly member Darrel Steinberg (D).Steinberg, in turn, attributes success to the fact that “everyone knows someone with mental illness. It is not about `those people.'”He added, “Mental illness is one of the long-ignored issues in society, but the irony is that it's personal to more people than we imagine.”“[We ran] a great campaign,” he said. “And, unlike many other good causes, we were also able to strike a chord with the voters.”Steinberg said he learned from traveling around the state campaigning for the initiative that there was general knowledge that Ronald Reagan, as the state's governor, had shut down many of the state mental hospitals in the 1960s.“Residents see the consequences of that decision every day in terms of homelessness and other social problems,” he said.The Campaign for Mental Health, which led the battle for the initiative, emphasized the idea that Proposition 63 would be a remedy for the state's broken promises to people with mental illness.Steinberg is completing his third term representing the 9th Assembly District, which includes most of the city of Sacramento. He became interested in the issue of mental illness when serving on Sacramento's City Council in 1996. The city sued a charity serving homeless people for violating a law concerning limitations on providing meals on Sunday.APA Assembly Speaker Al Gaw, M.D. (left), presents California Assembly member Darrel Steinberg with a Speaker's Award at last year's annual meeting in San Francisco in recognition of his support on mental health issues.The case, which attracted national media attention, was really about the city's frustration with dealing with homelessness, said Steinberg.He could see the linkage of the problems in Sacramento with the state's failure to honor its earlier commitments to provide community-based care after officials closed mental hospitals.Steinberg made mental health services a key element of his campaign for the state's Assembly in 1998. He began his service with hopes of passing a $350 million bill to rebuild the state's mental health system but soon confronted political realities that made passage unlikely and developed a more realistic goal.With the support of John Burton, president pro-tem of the California Senate, and the state's first lady, Sharon Davis, he secured passage of AB 34 in 1999. Initially funded at $10 million, the legislation supported Community Mental Health Demonstration Grants to serve adults with severe mental illness who are homeless or at risk of homelessness.Steinberg said, “I'm a stickler for accountability. We wanted to make certain the money would be well spent.”The bill required the state's Department of Mental Health to develop a reporting mechanism to conduct “extensive monitoring and evaluation” and report results to the legislature.Those evaluations helped secure an increase in funding to $55 million in subsequent years and were cited by advocates for Proposition 63 to persuade voters that funds will be well spent.The CPA has twice named Steinberg Legislator of the Year. The nonpartisan California Journal named him Assembly Member of the Year for 2004 and honored him as the Assembly's top member in the categories of integrity, best problem solver, and hardest working.Steinberg will leave office in 2005 because of term limits. “The number-one thing I want to do,” he said, “is to bring this program model to the rest of the country.”Information about AB 34 is posted at<www.dmh.ca.gov/PGRE/Integrated_Services.asp>.▪ ISSUES NewArchived

„Psychotherapiestation” der Klinik für Psychiatrie und Psychotherapie Bayreuth

Inpatients of "psychotherapeutic treatment units" at State Mental Hospitals in Bavaria are different from those treated in so-called psychosomatic clinics for rehabilitation, looking at additional criteria like psychiatric and somatic comorbidity or suicidal behaviour. Treatment concepts and results are respectable and comparable to so-called psychosomatic clinic. In this paper we describe the "Psychotherapy Unit" at the Clinic for Psychiatry and Psychotherapy Bayreuth. Depressive episode is the most diagnosis, with 1 to 4 comorbid psychiatric diagnosis in 82 % of all patients and 28 % with somatic comorbidity.

Psychotherapiestationen in den bayerischen Bezirkskrankenhäusern

In this paper we report about the situation of psychotherapeutic inpatient treatment in Bavarian state mental hospitals, based on data coming from surveys in those hospitals. 22 State mental hospitals in Bavaria have 1217 beds for acute psychotherapy, proofed on the basis of quality criteria. More than 50 per cent of all psychotherapy beds are located in those hospitals.

Veränderungen von Versorgungsstrukturen an einem Psychiatrischen Landeskrankenhaus

Changes in the provision of psychiatric services within the last decennials are probably best understood if the impact of national socialism on clinical psychiatry is regarded. Many psychiatrists took part in the "Aktion T4" the organised killing of their patients, at least they did not resist campaigns directed to killing or sterilisation patients. After WW II, a period of silence and acceptance of inhuman circumstances in the large mental state hospitals appeared, when in the sixties a new generation of psychiatrists was no longer willing to continue the traditional system of mental health care delivery. The Expert Commission on Mental Health Care reported a comprehensive agenda on reformation of service delivery in 1975, which was influential in the development of alternative structures of psychiatric services. Most mental state hospitals reduced their capacities and parallel to this process smaller units, devoted to principles of community psychiatry, associated to general hospitals were created. Overall, the number of hospital driven beds decreased at about 33 %, but in the large hospitals at two thirds within the last 25 years in Baden-Wurttemberg. This process of deinstitutionalization was accompanied by the development of structures for community care, internal reorganization and modernization, and important steps in budget development, which lead to better treatment opportunities for all kinds of psychiatric institutions. The concrete and historical reality of these circumstances and changes, and possible future directions are exemplified for the psychiatric hospital in Weinsberg.

A Proposal for Future Funding of Chronic and Episodic Mental Illness

The estimated 1.7 to 2.4 million Americans who suffer from chronic mental illness are poorly served by the current nonsystem of services. No agency at any level is responsible for coordination of funding, treatment, and care. Since the mid-1950s funding has become increasingly fragmented as state mental hospitals have been depopulated, community services have been developed, and federal entitlement programs such as Medicaid, Medicare, and Social Security Disability Insurance have been introduced. To overcome the problems of fragmented funding and uncoordinated services, the authors propose establishment of a new federal entitlement program for the chronic mentally ill that would pool all existing funds regardless of the source. States would be empowered to develop a single administrative agency with responsibility for coordinating a comprehensive program of services.