Traditional Mental Hospital Research Articles

A critical review of the antecedents of enabling communities

PurposeAdopting a sense of critical enquiry when examining historical sources, it is possible to gain a richer and broader sense of present practice. The aim of this study is to emphasise the importance of historical research to present practice in teasing out the different elements at work and how they developed. A core assumption is that our consciousness depends on our interactions with others.Design/methodology/approachThis study is part of ongoing research into the historical background of the practice of discerning compassion. The methods used include archival research and the reading of primary and secondary literature.FindingsIn particular, it becomes clear that this way of working is always going to be problematic for political authorities as it promotes the questioning of accepted beliefs. This study emphasises that the core concepts underlying enabling community practice reach deep into the past and involve events not usually associated with the traditional histories of the approach. In particular, exploring outside of the traditional mental hospital background reveals a greater involvement of women than previously demonstrated. There are processes that have deep historical roots, the culture of enquiry, the benefits of mutual support and the understanding that people flourish better interacting with each other in a supportive and trusting environment rather than through coercion and instruction.Research limitations/implicationsAs with all historical research, this paper is limited by the resources available to examine particular events.Practical implicationsRecognition of the importance of historical enquiry as relevant to present-day practice.Social implicationsHistorical enquiry helps to acknowledge the importance of social events in shaping our present understanding. As W.H. Rivers argues, we have to understand what happened in the past before comprehending why present sociological events occur.Originality/valueThis paper is a unique enquiry into the early historical antecedents of enabling community practice. It is intended to stimulate more research into the field and to stimulate debate about the relevance of particular aspects of practice. It refers to sources that are not usually part of such discussions and, by implication, suggests that there is more to be explored. It is not an exhaustive account and is to be supplemented by another paper on leadership.

Contending professions: sciences of the brain and mind in the United States, 1850-2013.

Argument This paper examines the intersecting histories of psychiatry and psychology (particularly in its clinical guise) in the United States from the second half of the nineteenth century to the present. It suggests that there have been three major shifts in the ideological and intellectual orientation of the "psy complex." The first period sees the dominance of the asylum in the provision of mental health care, with psychology, once it emerges in the early twentieth century, remaining a small enterprise largely operating outside the clinical arena, save for the development of psychometric technology. It is followed, between 1945 and 1980, by the rise of psychoanalytic psychiatry and the emergence of clinical psychology. Finally, the re-emergence of biological psychiatry is closely associated with two major developments: an emphasis that emerges in the late 1970s on rendering the diagnosis of psychiatric illnesses mechanical and predictable; and the long-term effects of the psychopharmacological revolution that began in the early 1950s. This third period has seen a shift the orientation of mainstream psychiatry away from psychotherapy, the end of traditional mental hospitals, and a transformed environment within which clinical psychologists ply their trade.

Thirtieth birthday of the Italian psychiatric reform: research for identifying its active ingredients is urgently needed

In 2008 Italian psychiatry celebrates 30 years since the passing of Italian Law Number 180, the reform law that marked the phasing out of psychiatric hospitals and the gradual development...

The Impact of Mentorship

Article AbstractThe impressive achievement of my former mentor, Thomas Becker, M.D., from the University of Ulm, Günzburg, Germany, had a formative influence on my career. Dr. Becker transformed a huge, traditional state mental hospital in southern Germany into a modern psychiatric university clinic with a strong research department. The mutual stimulation of practical psychiatric work and research based on clinical questions is one of the most powerful instruments to transform and improve services.

Characteristics of assaultive psychiatric inpatients in an era of managed care.

Prior to managed care, extensive research documented the characteristics of assaultive inpatients in traditional state mental hospital settings as primarily older, male, psychotic patients with histories of violence toward others and of substance abuse. Recent early studies in rural and urban hospital settings have suggested that the characteristics of assaultive patients may be changing to include younger, more frequently female, patients with personality disorders and histories of personal victimization. This two-points-in-time study sought to assess the nature of assaultive patients in a suburban traditional state mental hospital after the implementation of managed care initiatives, and compared to the nature of the assaultive patients before and after the downsizing of this state mental health facility. Before census reduction, the assaultive patients were of the traditional type. After census reduction, the assaultive patients reflected more recent trends. The implications of the findings are discussed, and strategies for fostering facility safety in light of the newer violent patient are outlined.

Alojamientos protegidos para enfermos mentales esquizofrénicos

Some schizophrenic mental health patients need to live in sheltered housing when their suffer severe impairment and functional limitations and it is not possible tó develop adequate means of external control, specific patterns for communication and tráiningmethods for the rehabilitation of daily life skills in their home context. In Andalusia, the reform of the psychiatric system has led to the closing of the traditional mental health hospitals and their replacement by new and diverse health services, and housing and employment resources. Most ofthe housing resources are already occupied by schizophrenic patients. There is a certain:amount of them in the province of Seville. However, their number should be increased. Other resources with greater support, more personnel, coverage of extended periods of time and less functional requirements for resident patients should be made available.

‘A ward in a street’

Attempts to deliver quality service outside the traditional mental hospital to those with chronic mental illness have resulted in several new models of care. We describe one such model of alternative care and asylum. Considerable improvements in quality of life, quality of care and clinical state occurred.

Interdisciplinary Treatment Team Training in Geriatric Psychiatry:

This paper describes the adaptation and implementation of an interdisciplinary treatment team training model to the training of geriatric psychiatrists. The Program for Organizing Interdisciplinary Self-Education (POISE) was designed as a durable, cost-effective approach to teaching interdisciplinary treatment team members methods of self-education, which serve as ongoing tools for planning treatment for patients. POISE is being applied to the New York State/Columbia University Geriatric Psychiatry Fellowship Program, a collaborative program of the New York Office of Mental Health, Columbia University Center for Geriatrics and Gerontology, and Willard Psychiatric Center, a traditional mental hospital in upper New York State.

A psychiatric unit in a general hospital in Brazil: predictors of length of stay.

The planning and organization of mental health care in developing countries frequently lacks empirical data. The World Health Organization recommended psychiatric brief inpatient programs in general hospitals for these countries as a cost-effective alternative to the traditional mental hospital. Length of hospital stay is a crucial factor in a cost-effective mental health care organization. In a newly organized psychiatric inpatient unit in a general teaching hospital in Brazil we investigated the influence of 16 socio-demographic and clinical variables on the length of stay. Distance from residence to hospital (P less than 0.10), clinical diagnosis (P less than 0.05) and religious affiliation (P less than 0.05) were significantly related to length of stay. Possible mental health care implications of this short stay program are discussed.

Undesirable reading: the real role of the clinical tutor

I was appointed clinical tutor at Knowle Hospital seven years ago with little idea of what my responsibilities would be. From the College literature (which I have not found very helpful) it seemed I was responsible in a more or less indirect way for the psychiatric education of most of those working in the hospital as well as of those local general practitioners who might refer patients here. In addition, all medical students in the place are my responsibility – a considerable number of young people. To complicate this task, our academic unit had moved out of Knowle two years before my arrival and new trainees were advised that Knowle Hospital (usually described as a ‘traditional Victorian mental hospital’) would be closing in the near future as modern community services were provided. Finally, the advent of proper management, welcomed by me, was spoiled by an indifference to psychiatric education which bordered on absurdity.

A cross-cultural comparison of mental health care delivery in Athens and Groningen

Until recently mental health care in Greece was mainly delivered by old traditional mental hospitals and few outpatient services. In order to induce the process of change the University of Athens started to experiment with a community mental health service. In order to study what has been achieved in a relatively short time, data relating to the delivery of care cohorts of patients from a pilot area in Athens and from an area in the north of the Netherlands were compared. The overall new contact rate was much higher in the Groningen area, except for the category of psychoneuroses and personality disorders. Patients with a psychosis received more intensive treatment and left the services at a later stage in Athens. Differences of patterns of care in other diagnostic and age groups are discussed.

Role Blurring in a Holistic Therapeutic Community

Role segregation, or the clear split between the role of staff and patient, has been a dominant feature of the traditional mental hospital and most contemporary community-based treatment facilities for the mentally ill. In contrast, this article reports on an innovative community-based therapeutic milieu for the chronically mentally ill in which a holistic healing philosophy and egalitarian ideology supports the blurring of roles of staff and patient. A detailed description and analysis of “role blurring' is offered that includes (1) an examination of its sources and organizational and therapeutic consequences, (2) the ways in which role and status are inevitably and subtly reasserted and differentiated by way of interactional strategies and structural factors, (3) this therapeutic community's place within the reforms of institutionalization and deinstitutionalization, and (4) a discussion of what other organizational contexts do and do not to promote “role blurring.”

Assessing the quality of residential services for people with mental handicap

Between 1984 and 1987 the South Western Regional Health Authority funded research to compare the costs and quality of alternative residential services for people with learning difficulties (mental handicap). During this period, 14 residential services were evaluated. The services covered a wide range of models of care and included: small homes run on ‘ordinary life’ principles based in the community, funded and/or managed by health authorities and social services departments; small (health authority) homes in, or adjacent to, mental handicap hospital grounds; traditional mental handicap hospitals; and private or voluntary sector hostels for up to 12 people.

The Effect of Community Care on Long-Stay Patients at Knowle Hospital

It was in 1961 at the Annual Conference of MIND that Enoch Powell first announced that the traditional mental hospitals were to be run down. Since then it has been government policy to emphasise the value of a transfer of care from hospital to the community. Concern was soon being widely expressed at the growing gap between statements of proposed government policy and their realisation. It has long been the intention to close Knowle Hospital, which originally served the city of Southampton, and over the last ten years there has been a gradual transfer of some of the services away from the main hospital site. A major problem in successfully implementing the closure of any mental hospital is the appropriate relocation of the long-stay population. The problems this involves have been much debated recently.

UNITS FOR THE CONFUSED AND DISTURBED ELDERLY: DEVELOPMENT, DESIGN, PROGRAMMING AND EVALUATION

In New South Wales, the implementation of the ‘new’ Mental Health Act and the deinstitutionalisation of Mental Hospital patients following the Richmond Report, have lent urgency to the need to develop specialised units and services for the confused and disturbed elderly.Experience gained working with this population in a traditional Mental Hospital has led to both an appreciation of the limitations of therapeutic programmes implemented within this setting and the designing of purpose built units appropriate to the needs of these patients.Units which will facilitate a Reality Orientation/Behavioural approach within a simple, domestic scale environment are now being built.This paper presents the developmental stages of this concept, describes the units' design and programmes and outlines the assessment and selection procedures.

Evaluation of a planned change on a long-stay rehabilitation ward.

This is an attempt to evaluate the results of planned changes on a long-stay rehabilitation ward in a traditional mental hospital in England. The ward was housing a mixture of groups of patients of differing types and needs. The results of our study suggest that it is possible to improve patient care and staff morale on similar wards without extra staff, money or structural changes. Good planning, collaborative teamwork and dedication were the main tools.

The mental hospital revisited: a program.

In a pilot program, an active, participatory treatment approach has been implemented in a 32-bed, inpatient setting at the Florida Mental Health Institute (FMHI) and appears to be more effective than a traditional mental hospital treatment modality. This report presents a description of the Psychosocial Rehabilitation Entry Project (PREP) at FMHI. The PREP program encourages client growth, independence, and responsibility through the use of a small group, peer-management approach. Research indicates that this approach results in a rehospitalization rate significantly lower than that of patients in a more traditional treatment program.

Observations on the behaviour of patients in a state mental hospital and a general hospital psychiatric unit: A comparative study

The study sought to compare the naturally occurring behaviour of psychiatric patients within a traditional mental hospital ward and a general hospital psychiatric unit. Direct behavioural observations were undertaken to determine the pattern of behaviour exhibited by patients, the amount of time spent in interaction, with whom interaction took place and the content of that interaction. Data were reliably collected by trained observers, using a 10 category behaviour scale. Within each setting 10 psychotic patients, matched for age, sex and diagnosis, were the subjects and 30 min of behaviour was recorded for each subject. Observations revealed that patients in the mental hospital exhibited more disturbed behaviour, and spent less time in interaction, than did those in the general hospital unit. However, the amount of time patients spent interacting with staff was comparable in the two settings, despite marked differences in staffing levels. Analysis of the content of interaction that did occur indicated that the manner in which staff responded to patients' behaviour was not consistent with the application of a behavioural engineering approach to the modification of abnormal behaviour. While staff in both settings were indiscriminate in the way in which they responded to appropriate and inappropriate patient behaviour, a rather more punitive style of interaction was observed in the mental hospital environment. It is concluded that, from a behavioural perspective, neither setting achieved an optimum therapeutic environment.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Client engagement

Systematic observational measures of the minute-to-minute behaviour of severely and profoundly mentally handicapped people of comparable levels of dependency were taken in two types of residential unit to establish the level of engagement in activity. Higher engagement levels were found among those clients living in Wessex locally-based hospital units compared with those living in villas of a traditional mental handicap hospital. Thus, concern that such small “domestic” units, sited in the community among the people they serve, would not be a feasible alternative to traditional campus-type hospitals appear to be unfounded. Moreover, the prediction that traditional practices, such as grouping clients by clinical or diagnostic criteria and grouping living units to provide peer “support” to staff and supposed better access to specialists, are essential to the maintenance of high quality residential care is not borne out by the evidence. More attention needs to be paid to the important variables of staff deployment and scheduling of activities in the maintenance of high levels of client engagement in activity.

Evaluation of alternative residential facilities for the severely mentally handicapped in Wessex: Revenue costs

The revenue costs of small locally-based hospital units for the severely and profoundly mentally handicapped in Wessex were compared with those of traditional mental handicap hospitals. Contrary to expectations, the revenue costs in such units were not excessively greater than average costs in many large mental handicap hospitals. Indeed, estimates of the cost per inpatient day in wards of two large hospitals in Wessex with clients of comparable degrees of dependency showed that revenue costs in the locally-based hospital units were competitive. Rationales of the inevitable presence of “economies of scale” should not be used in the perpetuation of large residential complexes; unsupported assertions of greatly increased running costs should not prevent development of small locally-based residential alternatives.