Linking Hospital and Community

A thorough crisis evaluation requires understanding of the client's premorbid personality, support systems, previous episodes of decompensation, past treatments, and the interaction of a precipitant with a particular personality structure. The key to a successful treatment model is the proper treatment of the client in his or her community. Thus, the development of adequate linkages within the system to support this effort becomes imperative. By utilizing problem-solving approaches and anticipatory planning, the Psychiatric Emergency Service is instrumental in achieving maximum positive outcomes through contact with the patient and multiple systems.

Twelve-step program use among Oxford House residents: spirituality or social support in sobriety?

Oxford House is a self-help, self-governed, democratic communal-living environment for recovering alcoholics and polysubstance abusers. In this study, 134 male residents (M age = 34 years old) were personally interviewed on their recovery process and, in particular, on their experience with 12-step programs such as Alcoholics Anonymous (AA). Most residents (76%) reported they attended weekly AA meetings to assist in their recovery, mainly to acquire effective techniques to maintain sobriety (72%). Many AA attendees (43%) claimed no sense of spirituality prior to joining AA, and for most of these men (71%), attendance at weekly meetings was not motivated by "spirituality" aspects of the program. In contrast, the majority of residents (53%) attending weekly AA meetings claimed that a sense of fellowship with similar recovering others was their reason for program involvement. It appears that among men living in a communal setting with other recovering addicts, the need for social support for sobriety from similar others continues beyond the confines of their residence.

A treatment system for combined psychiatric and addictive illness

Patients with combined general psychiatric and addictive disorders are a major public health problem in the US, and are being increasingly recognized as such world-wide. The authors describe a model treatment system for such patients in one municipal hospital in New York. It is composed of three complementary units: a locked ward, a halfway house and a day program. Treatment is based on a peer leadership approach coupled with professional treatment, and provides multiple levels of care to address the needs of respective patients. Of 464 admissions evaluated and treated, most were from disadvantaged minorities, homeless and abusers of cocaine. All were admitted with acute psychiatric or perinatal presentations, and carried Axis I diagnoses in addition to their substance abuse. Clinical experience over 6 years is reviewed, suggesting the feasibility of reorganizing general hospital psychiatric services to address the needs of the dually diagnosed.

Future time perspective and daily occupations of persons with chronic schizophrenia in a board and care home

OBJECTIVES

An ethnographic approach was used to study the relationship between temporal perspective in persons with chronic schizophrenia and their ability to function in chosen occupations and participate in the routines of a board and care home. Components of future time perspective (extension, coherence, and density) are associated with the ability to organize and implement goal-directed activities. The study focused on how future time perspective occurs in a board and care home, with particular emphasis on how the institution influences temporality.

METHODS

Participant observation and interviewing were used to gather data on 10 subjects.

RESULTS

The pervasive influence of the facility's institutional rules and expectations is revealed in the findings of subjects' present time orientation and limited future time perspective.

CONCLUSIONS

An examination of the fit between the demands of available roles within one's environment and occupations is proposed.

Substance abuse in adolescent mothers: strategies for diagnosis, treatment and prevention

Adolescent drug addiction and alcohol abuse are on the rise in this country. Teenagers of all races, socioeconomic groups and both genders have become avid experimenters with a full spectrum of substances, including alcohol, marijuana, stimulants, cocaine and hallucinogens. A diagnosis of addiction requires familiarity with the normative trends of adolescent behavior, as well as deviations from these trends. Moreover, an adolescent mother with a drug addiction problem confronts the additional burden of fostering adaptive developmental patterns in her infant. Treatment techniques such as previewing, which empowers through the representation and enactment of future outcomes, have helped addicted teenage mothers relinquish drug use and adopt more mature caregiving behaviors.

[Treatment with psychotropic drugs in various facilities for mentally handicapped patients]

798 mentally retarded adults (> 19 years) in different types of residential care were studied with regard to psychotropic drug treatment and associated behaviour problems. The frequency of psychotropic medication amounts to 11.2% for residents of community-based group homes, 31.4% for residents of large institutions and 74.6% for long-term care patients of a Psychiatric Clinic. Neuroleptics were the most often prescribed drugs. After controlling for the degree of mental retardation, it could be shown that for persons with behaviour problems the probability of psychotropic drug treatment was 3 times as high in the group homes, and 5.7 times as high in the large institutions, as for the corresponding groups without behaviour problems.

Personality patterns of male felons in a correctional halfway house setting: an MMPI typological analysis

The MMPI profiles of 184 male felons who were residing in a correctional halfway house setting were cluster analyzed using S. Johnson's (1967) method to empirically identify different personality types. The samples ranged in age from 19 to 60 years and included three legal status groups: state parole, federal pre-release, and state furlough. Eight MMPI groups were derived and interpretive summaries provided. The eight types were compared across 13 demographic and descriptive variables with significant differences among groups found for age, prior felony convictions, and prior incarcerations using ANOVA. Diagnostic and treatment concerns were discussed.

Episodic effects on picture identification for alcoholic Korsakoff patients

Experience with degraded pictures produces better subsequent identification of these pictures in amnesic patients. To examine the contribution of episodic memory to this facilitation, we compared identification of pictures that were identical to a studied picture, pictures that shared the same name with a studied picture, and new, unstudied pictures. In an initial phase of the experiment, patients clarified each picture until they could name it. During a second phase, they again clarified each picture and judged whether it was identical, similar (same-name), or different from pictures identified in the first phase. Korsakoff patients, as well as alcoholic controls, identified identical pictures faster than same-name pictures, and these in turn were identified faster than new pictures. The Korsakoff patients did show less facilitation than the alcoholic controls, but this difference was eliminated by testing the alcoholics after a week delay. The smaller facilitation in performance shown by amnesics and by alcoholics tested after a delay was accompanied by impaired recognition memory as well as by qualitative differences in recognition performance. The Korsakoff patients tended to label same-name pictures as different while alcoholic controls tested immediately called them identical, a tendency which disappeared when alcoholics were tested after a delay. These findings suggest that Korsakoff patients are influenced by specific episodic information even more than are alcoholic controls.

Social environments of adult homes

The purpose of this study was to examine the social environments of adult homes in the community to determine if different types of adult homes existed and which environmental variables best described each home type. Three hundred and two adult home staff rated 10 social environment variables of 49 adult homes using Moos' Community Oriented Programs Environment Scale. Using cluster analysis, 4 distinct environmental home types were identified. Discriminant analysis suggested that homes in each cluster differed primarily in their degree of staff involvement, staff support and expression of anger.

Changes in social support and quality of life: a case study of a man with an enduring psychotic illness

The Government's White Paper on community care has drawn attention to the importance of assessing changes in a person's well-being which occur as a consequence of clinical and social interventions. In the UK the evaluation of the quality of life of people with chronic mental illness is relatively new. This case study demonstrates the use of the 'Lancashire Quality of Life Profile' in routine clinical practice with reference to residential changes in the 'care programme' of a person with a long history of a severely disabling psychotic illness. The formulation and review of his care plan were determined by a network of agencies involved in his long term care.

[Outpatient care and social rehabilitation of psychiatric patients in a halfway house]

This paper deals with the foundation and the function of a half-way house, whose intention is the social and professional restoration of psychiatric patients. The half-way house is one of the latest developments of social psychiatry.

From hospital to community: a follow up of community placement of the long term mentally ill

AIM

To evaluate the planned movement of long stay patients with chronic mental disorders from Sunnyside Hospital into staffed residential accommodation in the community.

METHOD

Sixty-nine long stay psychiatric patients were followed up over 18 months to assess their social functioning, psychiatric symptomatology, resource use, relapse rate, satisfaction with their care, and impact on the community.

RESULTS

Social functioning and psychiatric symptomatology scores on the social behaviour schedule remained stable overall. Relapse rates were low, and rehospitalisation rare. Use of community and area health board resources tended to decrease. Over 90% of patient responses indicated satisfaction with their new living arrangements. Over 50% reported no contact with outside friends, though over the follow up period about 70% maintained at least monthly contact with relatives.

CONCLUSION

Careful community placement of the long term mentally ill, with ongoing supervision, can have a successful outcome from clinical, patient and community perspectives.

Caring in the preparation of long-term psychiatric patients for non-institutional care: ethnonursing study

Caring is the central and unifying domain for the body of knowledge and practices in nursing. It was the purpose of this ethnonursing study to describe caring in the residential training for long-term psychiatric patients in Finland in 1977-1988. Data were collected by interviewing 20 patients and 11 members of staff. On the basis of the empirical data, four stages of caring could be distinguished: formation, reformation, fragmentation and reintegration. The changes in caring occurred on the following dimensions: work for wages vs. vocation; spontaneous social interaction vs. the systematic instruction of practical skills; and collective activities vs. individual activities.

High needs and low priority of mentally ill residents of adult homes

Adult homes are a major residential resource for persons with serious mental illness. Although many adult homes provide sub-standard care and receive inadequate clinical support, little effective long-term action is taken to improve conditions. This paper describes factors that interact to create inertia in the adult home industry. They include a lack of effective regulatory agencies, unrealistic reimbursement policies, service delivery roles so broadly defined that they reduce the homes' power to complete for resources, clinicians' lack of identification with the industry, the scarcity of effective case management and service advocacy programs, and poor data bases. The interaction of these factors prevent owners of adult homes, other human service providers, and government agencies from establishing self-sustaining corrective mechanisms.