The Post-Hospital Mental Patient and Family Therapy: Prospects and Populations*

Changes in the pattern of delivery of mental health services have led to dramatic increases in the number of patients discharged from mental hospitals. These post-hospital mental patients represent a new challenge to the field of family therapy. Of the approximately 1 million patient admissions to state and county mental hospitals, general hospitals, and private psychiatric hospitals, over 380,000 are married, and more than half of the remaining patients are estimated to be living with family. Almost 135,000 admissions receive family therapy during their hospitalization, and an estimated 650,000 mental patients will return to their families upon discharge.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

Mandated benefits for a new provider class: LICSW's

The purpose of this study is to assess the initial impact of Licensed Independent Clinical Social Workers (LICSW's) as a new reimbursable provider class in an insured population with mandated nervous and mental benefits. History of nervous and mental therapy, previous provider type, age, and sex are examined. Data were obtained from Blue Shield of Massachusetts' nervous and mental claim information from 1979 through 1982 for all patients who saw a social worker during the year of LICSW certification. Results show (1) a large majority of the 1982 social worker patients had no billable psychiatric experience for the three years prior to 1982; (2) the longer a patient is in treatment, the less likely is a provider type switch; and (3) psychologists' patients are more likely to switch to a social worker than psychiatrists' patients. A concern remains for this insurer over the increase in the total number of psychiatric services concomitant with a new provider class introduction.     

A case for psychodynamic social work

Abstract

Psychodynamic casework is not as popular in social work theory and practice as it once was. It is considered by some to be impractical, unscientific, and not suitable for those customarily receiving a social work service. Task-centred casework, behavioural approaches, the newer psychotherapies, and family therapy have all taken over as major paradigms of social work method. This is especially so, I think, for the social worker working in a psychiatric setting, where many clients stay only for a short time and where emphasis is placed on assessment and short-term intervention.

In this paper I shall argue that a psychodynamic approach in social work is still relevant; that it is important for its humanizing qualities, for understanding and working with people with severe problems and for, perhaps, helping us to locate the position of social work vis-a-vis other mental health professions. I shall do this by focusing on a particular case I had as a social work student on placement in a psychiatric day hospital.     

Therapeutic stations and the chronically treated mentally ill

Readmissions to mental hospitals are often cited as evidence of the failure of the contemporary mental health system. This essay proposes a different interpretation of readmission. Building on fieldwork and participant observation methods, the authors argue that the "veteran" patient is less a victim of poor psychiatric care and misdirected reform than he is a citizen with few personal resources, using public services to cope with the exigencies of life. Lacking family, job, and income, the ex-patient incorporates the hospital and other "therapeutic stations" into a resource pool upon which he or she can call when the need arises. The essay also discusses the implications of these findings for assessments of the community mental health movement.     

The Atascadero State Hospital experience. Engaging patients in violence prevention.

When it comes to caring for the forensic psychiatric inpatient, there is no "how to" book. In the forensic hospital environment, the commingling of severe and persistent mental illness with criminality poses vexing clinical challenges and complex moral dilemmas not faced in either general psychiatric or correctional environments. While providing evaluation and treatment in our maximum security forensic environment, we continually strive to create and maintain a therapeutic milieu as we fulfill our social mandate to protect the public from the dangerous "criminally insane." Few studies guide us. We do know that within the forensic population there is a spectrum of psychopathology to manage, some of which responds to traditional psychotherapeutic techniques and some of which does not. For example, patients with psychopathic traits may not respond well to traditional treatment methods (Rice, 1997). As forensic psychiatric staff, we sometimes feel as if we are making it up as we go, adapting and blending psychiatric theory with knowledge from penology and criminal justice science to provide a safe environment conducive to growth for patients, the majority of whom may be considered "violence-prone" persons (Toch, 1969). Change is a characteristic of public-sector settings (Smoyak, 1991). Forensic hospitals must continually strive to monitor, refine, and improve their organizational systems as they respond and adapt to constant change. Despite the inherent challenges posed when collaborating with forensic patients, the VAC has achieved some notable successes. Staff and patients have been encouraged to work together to create and maintain a milieu where violence is neither assumed nor condoned. An active collaboration and partnership with our forensic patients has been one component of the hospital's successful violence reduction program. We trust that ASH's successful effort to collaborate with patients on the issue of violence reduction may be of use to other forensic hospitals faced with similar challenges.     

Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.     

Caribbean Families: Social and Emotional Problems

Families from the English-speaking Caribbean now comprise 30% of immigrants in New York State. Given the increase of Caribbean referrals to psychiatric hospitals and mental health clinics, it is important to begin examining more seriously the needs of this immigrant group. The concept of mental illness, risk factors that can lead to mental disorders, commonly accepted psychopathological disorders, issues in assessment and treatment as they apply to this cultural group are discussed in this article. A model for treatment—the multiculutral/multimodal/multisystems approach is examined.     

A psychiatric nurse's role

1. Homelessness in America is a result of complex social, political, and economic forces; approximately one third to one half of the homeless have severe emotional problems. 2. The person with chronic mental illness who is also homeless will face numerous obstacles when the need for psychiatric care arises. 2. The person with chronic mental illness who is also homeless will face numerous obstacles when the need for psychiatric care arises. 3. The federal government is beginning to address the problems of the homeless chronically mentally ill population by establishing pilot programs in Veterans Administration hospitals. 4. The psychiatric nurse is in a unique position to provide services to those who are homeless and mentally ill.     

MATERIALISTIC VALUES IN HONG KONG AND GUANGZHOU: A COMPARATIVE ANALYSIS OF TWO CHINESE SOCIETIES

This article integrates two competing perspectives on value orientation. Inglehart's postmaterialism thesis stresses the permanent effects of childhood experience in which economic deprivation leads to materialism in adult life. The human development perspective, in contrast, emphasizes the evolution of a person's value system as life-cycle development unfolds new circumstances and possibilities. We adopt a developmental framework to test claims from these two perspectives. On the basis of micro-level data, we compare the materialistic values of two historically and culturally different Chinese societies, Hong Kong and Guangzhou. Findings support Inglehart's assertions that childhood experience has lasting effects and that rapid social changes create birth cohort differences in materialistic concerns. But life-cycle developments, such as education, marriage, and current social status, are equally important in influencing a person's value orientation. Both perspectives see only part of the picture, and an integrated approach is needed to better understand how people construct and maintain their value system.     

Popular opinion is not empirical data

Conclusion It is not the purpose of this paper to defend psychiatric diagnosis; the reliability, validity, and the process itself have been found lacking in many respects (Zigler & Phillips, 1961) and it is becoming increasingly difficult to justify the current system. Rather, the purpose of this paper has been to examine the claims and conclusions concerning psychiatric diagnosis as presented in Rosenhan's article, On Being Sane in Insane Places. As has been pointed out, this study has methodological and logical difficulties which render its conclusions, as stated, invalid or questionable in nature.The currentzeitgeist is in favor of criticizing psychiatric and psychological thinking and practice in relation to mental illness. It is suggested that there is no such thing as mental illness (Szasz, 1960), that diagnosis is useless (Sarbin, 1967), that symptoms are socio-psychological in nature (as if this makes them less real), and that self-fulfilling prophecy accounts for the current overcrowding in mental hospitals. All of these things may be true. Or, they may be erroneous assumptions. Certainly, they are factors which mental health professionals must consider. However, this consideration must be careful, objective, and analytic in nature in order to avoid the bandwagon effect. It is hoped that his paper may contribute to a more evaluative demeanor on the part of all mental health professionals.     

Experience in developing a Transitional Employment Program (TEP) for the psychiatric patients in an acute general hospital in Hong Kong

This paper describes the application of a transitional employment program (TEP) for psychiatric patients in Hong Kong. The TEP and its values in psychiatric rehabilitation are introduced. The differences between TEP and Supported Employment (SE) were also highlighted. A TEP for psychiatric patients in an acute general hospital is outlined. Interviews of employer and trainees showed that, apart from increasing income, qualitative changes in the trainees were observed such as increased self-confidence, improved assertive and social skills, and increased work tolerance. Ongoing objective measurement should be conducted to demonstrate its effectiveness. TEP could be considered as a feasible alternative of vocational rehabilitation for patients with mental illness.     

Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes

The effects of traumatic exposure have been researched for many years and studies have shown that the parts of the brain affected by sexually traumatic experiences in childhood are also linked to many physical and psychological problems, such as depression, posttraumatic stress disorder, somatic complaints and suicide. Neuroimaging studies have provided a breadth of evidence that childhood sexual abuse is related to structural changes in the brain. Taken together, childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health. Several limitations of neuroimaging research on childhood sexual abuse are discussed, including a lack of refined and sensitive neuroimaging measures and problems interpreting results of structural imaged subjects with associated psychiatric conditions. Future, large‐scale studies are warranted to examine the type and severity of the sexual abuse and how each of the levels of childhood sexual abuse contributes to structural and functional changes. Furthermore, future studies are needed to control for comorbid psychiatric conditions in order to disentangle the effects of childhood sexual abuse from psychiatric conditions that damage brain development. © 2018 John Wiley & Sons, Ltd.

‘Childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health’

Key Practitioner Messages

• Childhood sexual abuse is linked to observable structural changes in the brain.
• These structural changes in the brain are associated with a myriad number of negative psychological effects.
• Research is limited in elucidating the role of childhood sexual abuse on brain development, as the bulk of the research has focused only broadly on child maltreatment.

     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Teaching Note—Integrating Prevention Content Into Clinical Social Work Practice Courses

Rapid changes in health care services and delivery suggest an upcoming paradigm shift in the field of mental health. Recent national reports, health care policy changes, and growing evidence support a shift toward prevention-focused mental health care. The social work profession is uniquely positioned to act as leaders in this shift as the profession’s values, goals, and hallmark practice approach are consistent with preventive care. Most social work students, however, do not receive training in prevention practice. The author’s development, implementation, and evaluation of a prevention-focused master of social work elective in the area of mental health is presented as an example of integrating prevention content into clinical social work practice courses. Implications for social work education are discussed.     

Social psychopathy,social distress,family breakdown,and custody disputes in the 1990s: Implications for mental health professionals

The decade of the 1990s will probably contain more challenges to the role of the mental health practitioner in child custody cases than ever before in history. Because of increasing social stress and family disintegration, custody disputes are destined to become more frequent, bitter, and traumatic for all parties. Mental health professionals, in particular, need to develop a coherent structure regarding their own participation in this process. Issues of moral changes among our leadership and our citizenry are examined and guidelines for the behavior of the mental health practitioner in the courtroom are formulated and illustrated as they pertain to custody decisions. Particular attention is paid to custody decisions as an art rather than a science, the role of empirical research, the need to anticipate certain unintended circumstances, the need for the application of mental health principles on an individual case-by-case basis, the nature of the mental health professional's expertise, and the problems with the concepts of parental unfitness and the use of psychiatric diagnosis as a way of defining such alleged unfitness.     

主题与变奏——基于对20年来中国青年价值观演变的结构分析

社会结构的变迁,必然导致人的文化价值观念结构的变迁。初创于20世纪90年代中国社会主义市场经济,带来中国社会结构的巨大变动,同时也是青年价值观变化最快、最深刻的时段。该文聚焦于“后一代”青年特性融入社会结构变迁这一背景,分析其时代特性以及社会结构的嵌入性。近20年来,青年在接受社会文化和价值观影响的同时,也在不断地挑战主流文化及其价值观,创造其新的文化和价值观。因此,主导价值观被青年所认同与接受的同时,也将更多吸纳青年价值观中具有活性的成分．从而使社会主流意识因为得到青年文化的反哺而走向年轻。     

Ancient Greek psychotherapy for contemporary nurses

Ancient Greek physicians as well as philosophers were fully cognizant of a human being's psychological function and used their particular art to influence individual or social behavior in accordance with their pursuit. This art or technique favorably compares with several of the methods currently called supportive psychotherapy. This psychotherapy was the first form of care for people with mental health problems. Nurses who base their practice on ancient Greek psychotherapy see the patient as a whole, a person who creates meaning in life. Applying the philosophical principles of ancient Greeks helps nurses understand the behavior of people with mental health problems and recognize and facilitate adaptive satisfaction of these psychological needs. In addition, psychiatric nurses are able to help distressed individuals understand their fears and anxieties, so they are freed from the causes of their symptoms that led them to seek therapy in the first place. Consequently, this understanding can make psychiatric nurses' work a living experience and add meaning to their work.     

A Social Constructivist Perspective on the Potential Relevance of Selected DSM‐5 Disorders for South African Children and Youth

In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM‐5 category changes — regarding post‐traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post‐colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.