Heterosexual relationships of psychiatric patients established during their treatment

Thirteen cases of sexual partnership established during psychiatric treatment, where both partners suffered from a psychotic disorder, were studied. Poor selection of a mate, in terms of excessive differences of their ages, educational background and social status can be viewed as one facet of behaviour affected by mental illness. No patients derived support from such relationships, nor were stabilizing effects on the patients' psychopathology observed. It seems a fully justified conclusion that such relationships cannot be viewed as positive with respect to the stabilization of the patients' mental conditions and that they should be discouraged.

The principle of separate responsibility in clinical psychiatric practice. 6 years' experience

An experiment lasting 6 years with an organizational principle called 'separate responsibility' is described. Its aim was to promote open two-way communication in an acute psychiatric admission clinic, by dividing power, i.e. responsibility for individual patients and patients as a group, over two multidisciplinary treatment teams. Multidisciplinarity, however, turned out to be impossible to maintain for different reasons. Instead, a splitting occurred of medical and nursing disciplines through identification of the former with individual treatment and of the latter with the patient groups. An unproductive loss of common treatment goals was the result leading to a near closing down of the clinic. Putting medical and nursing personnel into one team, responsible for the entire treatment of the unit, restored productivity and improved treatment and the working climate.

Antipsychotic drugs in community-based sheltered-care homes

This research describes the extent of use of antipsychotic drugs in sheltered-care and examines the effect of these drugs by dosage, age group and psychopathology on rehospitalization and social integration.

Data were collected from a large sample of former mental patients representative of all non-retarded mentally ill between 18 and 65 living in community-based sheltered-care in California.

Findings suggest that antipsychotic drugs, when used with limited medical supervision, have detrimental effects on the social functioning of the least disturbed. While antipsychotics may short circuit the psychotic process and thereby reduce mental hospital readmissions, social programming is necessary to promote better social functioning.

[Mentally handicapped: developing a personality of their own. Tasks in the planning of housing facilities]

The bases for material existence of mentally handicapped people is actually guaranteed in European countries, but the possibility for them to choose their own way of life is still strictly limited. The "principle of normalization" which is put forward here as a planning principle has nothing to do wih the normality of people but tends to normalize their living conditions. A mentally handicapped person should be allowed to live like any other citizen of his country as fat as he is capable to. Departing from the course of life which is usual in a certain country we have to plan an amount of institutions and services of assistance in order to diminish gradually the segregation of the mentally handicapped. Subsequently a concept for organizing the network of institutions and services needed is proposed, and a short outline of the actual situation of mentally handicapped people in the Kanton of zürich (Switzerland) is given. Hence the author presents 2 examples of environmental conditions which can be planned and built: - Dwelling establishements for mentally handicapped adults - The school for mentally handicapped children at Humlikon (Switzerland).

Effective functioning of chronic psychiatric patients in aftercare settings

The purpose of this study was to determine personality and environmental characteristics as they relate to effective functioning of chronic psychiatric patients in aftercare settings in North Western Ontario. The guiding assumption was that indices of health are better predictors of effective functioning than the absence of pathology.

[Patterns of psychiatric follow-up care outside the psychiatric hospital (author's transl)]

This study was devoted to collecting information from 57 psychiatric hospitals in the Federal Republic of Germany with regard to the quality of the care afforded to chronic psychiatric patients. The study took place during 1977/1978, and concerned the therapeutic and general quality of transitional hostels, homes for long-term follow-up care, and homes for the aged and multiple-handicapped patients. At the same time, the present-day effectivity of sociolegal rehabilitation aid measures was compared with the results of corresponding opinions polls conducted in 1973/1974. The following conclusions were drawn: 1. "Non-clinical" mental health care of chronic psychiatric patients (mentally handicapped persons) requires specific pedagogico-therapeutic programmes specially adapted to the requirements of these patients. These requirements differ considerably from the conventional style of "ward care" which has developed in psychiatric hospitals. Regional fusion or co-operation of these homes is strongly recommended. 2. The effectivity of sociolegal rehabilitation aids for the mentally handicapped continues to be very low. This is partly due to the poor level of training and knowledge of the therapeutic personnel. Hence it is absolutely imperative to arrange for knowledge of this admittedly rather dry sociolegal subject matter, by means of suitable training and instruction.

[Group living of psychically/mentally disabled in state-assisted housing (author's transl)]

Lasting rehabilitation success is proven to be achievable through appropriate follow-up care. A group living project for five rehabilitees had therefore been established in the state-assisted housing sector, after selection of a suitable group of inpatients for this model project. Among the criteria for selection were: rehabilitation success so far, i.e. vocational reintegration, and suitability for group living. The difficulties encountered in the search for an appartment are described. The concept of our group living project included joint living of attendent and rehabilitees for an unlimited period of time. The case histories of the residents are outlined to give an idea of duration and severity of illness, and thus to enable evaluation of the risk involved in discharge from inpatient care. All clients have dependence problems, and had for this reason alone already been refused by other follow-up facilities. Three of the group members had to be exchanged after twelve months, loss of employment occurred only once. The initial difficulties and tasks of the attendent are described.

The first year of abstinence; notes on an exploratory study

Persons who stopped drinking while living in a halfway house ate and slept better, smoked less, drank more coffee, experienced more mood swings but fewer tensions, and had more problems in drinking situations than did persons who stopped drinking while living with their families or elsewhere in the community.

A weight reduction model for mildly retarded adults living in semi-independent care facilities

A behavioural weight reduction treatment model for use with retarded adults is discussed. The model describes five stages of the treatment programme. Instructional components and techniques are reviewed. The model was designed for implementation by nurses, dieticians, and other nutritional health educators.

Board-and-care home wanderers

At six-month follow-up, 32 of 101 psychiatric patients in a board-and-care home had moved on. In this sense a considerable proportion of this population is not a static group. A relationship was found between moving on and having resided in the board-and-care home 12 months or less, being younger than 30 years of age, having goals to change something in one's life, and hospitalization during the preceding year. Repeated attempts at independent living appeared to stem from a search for autonomy and a sense of mastery, and resistance to the pull of dependency. Moving on, for some, seemed to be an attempt at a geographical solution to internal problems. Ambivalence and the need of both residents and families for respite appeared to be reflected in moves back and forth from living with each other.

A cookery book for self-catering mentally handicapped

The more able patients from hospitals for the mentally handicapped in Southmead Health District Bristol, are being established in minimal-support homes. Dietitians were asked to advise on how to teach practical cookery skills and encourage good nutrition. They were unable to recommend any of the available cookery books, and have designed a recipe folder in picture form of suitable meals for one week. The mentally handicapped patient's background is discussed as it relates to the practical problems of rehabilitation.