The emerging role of the social worker in a psychiatric emergency service

A unique round- the- clock service has evolved out of the need to provide extended emergency coverage in the Milwaukee County Mental Health Center despite the dearth of psychiatric personnel. Psychiatric social workers, who see themselves as specialists in social functioning, have developed a combined intake-evaluation unit that sees all walkins, discusses prospective admissions, and considers alternatives to hospitalization. Using crisis intervention-psychiatric emergency criteria, they determine with applicants and referral sources the degree of disruption, the need for immediate action, and the most appropriate facility to handle the current situation. This is seen as a new extension of the traditional social work role, in the context of community mental health developments.Mr. Hyttinen and Mrs. Golan were the first psychiatric social workers instrumental in developing the Psychiatric Emergency Service (PES) and they remain on the part-time staff. The PES has been partly supported by a grant from the National Institute of Mental Health (R20 MH 01839-04) and is under the overall supervision of Dr. Charles W. Landis, Director, Milwaukee County Mental Health Services.     

The role of the certified social worker in England's social services.

With the reorganization of England's social services into a single unified system, the professional called the certified qualified social worker is playing a key role in the administration and delivery of community services. The author describes some of the worker's activities and also presents an overview of hospital, day treatment, and outpatient services for adult psychiatric patients in the county of Warwickshire. One of the most effective programs is a system of voluntary group homes, operated by an area council of churches, for former psychiatric inpatients.     

The role of facility management in psychiatric hospitals

Executive managers can ensure the most efficient management of the physical assets of their psychiatric hospital by involving the facility management staff in all phases of all planning and implementation. This paper stresses how maintaining expert in-house staff and equipping them with comprehensive computer-based tools results in the efficient use of available space and in good management of both capital and operating expenses. As the hospital liaison with outside design firms and regulatory agencies, the facility management staff can effectively communicate the facility's requirements and represent its interests.     

Review board outcomes for involuntary patients in provincial psychiatric hospitals.

OBJECTIVE: To identify long-term trends and compare different psychiatric hospitals with regard to outcomes of involuntary certification. METHOD: Data on outcomes of involuntary certification were obtained from the London and St Thomas Psychiatric Hospitals for 1987 to 1997, from the Psychiatric Patient Advocate Office pertaining to 10 psychiatric hospitals for 1987 to 1993, and from published data from the North Bay Psychiatric Hospital for 1992 to 1994. Data were compared regarding outcome variables. RESULTS: There are variable rates and proportions among the psychiatric hospitals for outcomes of involuntary certification, including patients choosing to withdraw their applications to Review Boards, physicians cancelling involuntary certificates by completing Form 5s, and Review Boards rescinding certificates. Overall, few certificates were rescinded by the Boards, a trend that was even more pronounced in recent years. CONCLUSIONS: Patients who are in psychiatric hospitals on an involuntary basis are infrequently released from hospital as a result of a Review Board rescinding their certificate.     

The role of the social worker in an experimental community mental health clinic: Experiences and future implications

This paper discusses the role of the social worker in an experimental community mental health project designed to evaluate the treatment of schizophrenics in a home-care setting as compared to a hospital setting. The clinic utilized throughout this project served both as a medium of research and as a source of direct services to the patients and families involved. In this paper the role of the psychiatric social worker is evaluated and described showing both its traditional as well as innovated aspects in hopes of offering a possible prototype of the social worker's role in future community mental health programs.     

The role of negative affectivity and social inhibition in perceiving social threat: an fMRI study

Personality is associated with specific emotion regulation styles presumably linked with unique brain activity patterns. By using functional magnetic resonance imaging (fMRI) in 26 individuals, the neural responses to threatening (fearful and angry) facial and bodily expressions were investigated in relation to negative affectivity and social inhibition. A negative correlation was observed between negative affectivity and activation of the amygdala, fusiform gyrus, insula and hippocampus. Increased activation following threatening stimuli was observed in the left temporo-parietal junction and right extrastriate body area correlating with more social inhibition traits. Interestingly, the orbitofrontal cortex, superior temporal sulcus, inferior frontal gyrus (Brodmann area 45) and temporal pole correlated negatively with negative affectivity and positively with social inhibition. Whereas individuals with increased negative affectivity tend to de-activate the core emotion system, socially inhibited people tend to over-activate a broad cortical network. Our findings demonstrate effects of personality traits on the neural coding of threatening signals.     

Adults with Autism Spectrum Disorders using psychiatric hospitals in Ontario: Clinical profile and service needs

BackgroundAdults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual disabilities (ID).MethodA secondary analysis of data from the 2003 Comprehensive Assessment Projects from three psychiatric hospitals in Ontario was conducted to describe patients with ASD and ID and to determine how their profile compared to other hospital users.ResultsTwenty-three patients with ASD and ID were matched on gender and patient status (inpatient/outpatient) to individuals with and without ID. Individuals with ASD and ID were similar in terms of demographics to patients with and without ID. However, individuals with ASD and ID were younger, spent more days in hospital and were less likely to have a psychotic disorder diagnosis than both patients with and without ID. Inpatients with ASD and ID were recommended for a higher level of care than hospital service users without ID.ConclusionsClearly, this small sub-group of individuals within the hospital population has high clinical needs that are not always well met.     

Overcoming social amnesia: the role for a social perspective in psychiatric research and practice

Psychiatry's reliance on biological models has resulted increasingly in the social realm's being dismissed or trivialized. The author examines the adverse consequences of this situation for psychiatric research and practice and suggests methods for addressing the problem. He describes how the social perspective has been extruded from discussions about the definition, future, and accomplishments of psychiatry, and he reviews four areas in which the biological model has produced unvalidated assumptions about the etiology, course, and prevention of mental disorders. The author shows how the social realm is intrinsic to concepts of mind and mental illness, and he describes seven ways in which a social perspective can provide a complement or a corrective to the prevailing assumptions of biological models, indicate new points of departure, and suggest methods for psychiatry's expansion.