A consumer's view of California's Mental Health Care System

Public policy and mental illnesses: Jimmy Carter's Presidential Commission on Mental Health

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.

Housing satisfaction, preference and need among the chronically mentally disabled in Hamilton, Ontario

This paper examines housing satisfaction, preference and need among a sample of the CMD in Hamilton, Ontario. The research goes beyond simply documenting the gap in housing supply by examining issues of housing quality as expressed by clients themselves. Survey data were obtained in two rounds of interviews from 66 clients attached to three aftercare programmes. Various indicators were consistent in showing a relatively high level of satisfaction with the current living situation. At the same time, clients reported major housing difficulties due to lack of appropriate and affordable accommodation, unacceptable conditions and financial constraints. Housing satisfaction was a significant correlate of scores of coping indices. There was considerable variability in satisfaction within groups of the sample defined in terms of type of housing, location and living arrangement. Data on preferences and expressed needs correspond quite closely with normative prescriptions for a continuum of housing options ranging from restricted congregate care to autonomous individual living situations. These findings underline the heterogeneity of the CMD and their needs.

[The psychiatric hospital: from yesterday to tomorrow]

A study carried out in a psychiatric hospital in the Montreal region reveals that in spite of deinstitutionalization, long-term stay remains an important factor in the use of beds. For some patients the hospital remains a permanent home, either from their first admission or from the time they are institutionalized after multiple admissions. For both in- and out-patients, return to the hospital and long-term care are almost inevitable. Generally speaking, the services of the hospital are used by the same long-term patients, and this to the extent that the hospital cannot provide services to other establishments or play its second-line role. This is frustrating for other institutions in the network, even though they accept the inevitability of the situation given the lack of adequate community resources for these patients. One of the primary functions of a psychiatric hospital also seems to be to fill in the gaps in the service network. In this regard, its expertise in the field of intervention in chronic psychiatric patients must not be overlooked. Given the current situation, the hospital's responsibility in regard to second-line services cannot be clarified until it has been determined just how much of the responsibility for care of psychiatric patients can be assumed by the community itself.

Psychiatric malpractice due to ignorance. Reports of cases of psychiatric treatment and traumatic neurosis handled by the doctor's liability board in which damages have been claimed

During the last 15 years, the Finnish insurance companies' doctor's liability board has handled six cases in which damages were claimed for psychiatric treatment or traumatic neuroses. Reports of these cases, grouped according to basis of indemnification, are given above. The board considered two of the claims unjustified and four justified. The party liable for damages was, in every case, the hospital. In Finland, claims for damages lodged with hospitals and doctors have not been very common. This is partly due to Finnish legislation. Claims for damages arising from psychiatric treatment are rare. In Finland, the party primarily responsible for injury to a patient is the employer (e.g. a hospital) and only secondly an employee. In practice, it is rare for a doctor to be required to pay damages for malpractice or neglect.

Priorities for long-term care: comments from board-and-care residents

In these times of shrinking human services resources, establishing clear service priorities becomes all the more necessary. This is particularly true for the care of chronically mentally ill persons, whose many needs place high service demands on the care system. As a group these patients rarely have a say in the establishment of service priorities. To obtain a better idea of their perceived needs, we asked 278 randomly selected, mentally disabled residents in 30 Los Angeles board-and-care homes about their current life conditions and problems. Their responses to open-ended questions about recent sources of unhappiness and desired changes were compared with quantitative measures of life satisfaction in several life areas. Unemployment, poverty, and housing were the areas in which patients most consistently expressed dissatisfaction and desire for change. Also, mental health problems, including interpersonal and family difficulties, caused frequent day-to-day unhappiness for them. These findings underscore the need for social service programs that adequately address patients' problems of living, in addition to continuing efforts to meet their mental health needs.

The impact of recent rehospitalization on community adjustment

In a study of 499 formerly hospitalized mentally ill residents of comunity-based sheltered-care facilities in California, results indicate that rehospitalization serves as a means of, ‘updating’ the chronic patient’s treatment. By returning to the hospital the patient is linked to the service system and its newest benefits accrue to him. In the absence of a care system which can more effectively link chronic patients to available services, rehospitalization may serve an unforseen positive function.

Client participation in CMHC program evaluation: increasing incidence, inadequate involvement

Client satisfaction surveys and client complaint systems are used by more CMHCs since the Amendments of 1975 required centers to evaluate "acceptability of service," but clients are seldom actively involved in designing or administering these evaluations. The authors argue that greater control by clients is merited on technical and political grounds, and would increase the likelihood that program improvements would result from assessments of acceptability.

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.

Community mental health myths and the fate of former hospitalized patients

This paper addresses one of these important emerging problems--the fate of former hospitalized patients--and the policy issues that the problem raises. The discussion is derived from observations of the experience of the mental health system in the State of Hawaii, but the issues raised are of relevance to other states as well.