Homeless mentally ill or mentally ill homeless?

Mainstream psychiatry conceptualizes people who are homeless and mentally ill as distinct from other homeless persons because it is thought that their status stems from their mental disorder and the poor implementation of deinstitutionalization. The authors believe this dichotomy is illusory. They present data indicating that recent socioeconomic and political shifts contributed greatly to homelessness among all groups, regardless of mental illness; that those with and without mental illness have similar biographical and demographic profiles; that high levels of mental distress are common to all homeless persons; and that few mentally ill homeless persons require involuntary hospitalization. This perspective suggests novel responses that de-emphasize clinical solutions and focus on empowerment, consumerism, entitlement, community-level interventions, and closer alliances with other advocates for the homeless.     

Physically ill and mentally ill

Undetected physical illnesses in psychiatric patients are common. Why do so many physical illnesses go undetected? These disorders are difficult to detect and need an elaborate consultatory process. Some of the problems may be related to the fact that psychiatrists do not do physical examinations. Clues suggesting an organic etiology may be attributed to psychodynamic issues by many physicians. In this paper, seven case reports are presented to illustrate the following: perform your own physical examination; do not attribute physical signs to dynamic issues; all physical signs should be explained; be alert to atypical presentations; conduct relevant laboratory workup; avoid bias against unattractive patients; and pose specific questions to consultants.     

Semi-independent living for the long-term mentally ill

This article describes a program developed in Burnaby, British Columbia in early 1981 to provide former boarding home clients with placements in unsupervised group home settings. The article also demonstrates how the mentally ill can foster solutions to their housing problems by means of participation in a special needs housing society.     

Community care for the chronically mentally ill

This article has presented the background, history, examples, and analyses of community care programs for the chronically mentally ill. From these data, it is concluded that such programs are as if not more effective an cost-efficient than conventional inpatient programs plus conventional follow-up for this population. The future, however, may depend much more on current political and economic trends than the scientific data available.     

Training residents to care for the mentally ill

Recent changes in Royal College training requirements have highlighted the need for residency programs to be able to offer challenging and worthwhile experiences to their trainees in caring for the chronically mentally ill. This training should bring them into contact with patients at each stage of their illness and recovery and expose them to the different settings in which treatment or management takes place. Postgraduate programs face many problems in organizing this teaching that arise from the nature and course of long-term psychiatric illnesses, the organization of residency training programs, attitudes and preconceptions of residents and teachers and competing time demands. The authors review these problems, identify specific goals for the training and suggest strategies for achieving these goals. Expectations of postgraduate programs, clinical placements, supervisors and residents themselves are outlined.     

Intensive case management for the seriously mentally ill

director of the Community Services Division and is currently director of Outpatient Services     

Evaluating prosthetic technology for the chronic mentally ill

As treatment and rehabilitative approaches evolve, mental health administrators face an increasing number of choices in developing supportive service delivery systems for chronic patients. This paper reintroduces and elaborates upon the concept of prosthetic technology to provide administrators with a tool to aid their program selection decisions. A method is described for evaluating the prosthetic efficacy of program interventions.