Community support services and functioning of the seriously mentally ill

A cohort of 729 chronically mentally ill patients receiving community support services (CSS) were followed over a nine-month period. Receiving needed community support services was shown to predict change in client functioning as measured by the Global Assessment Scale (GAS) even after the initial values on the GAS, as well as demographic, psychiatric, residential and medication maintenance variables were considered. Adequacy of social support from family, friends and others also contributed to predicting change in global functioning of the CSS patients.Johns Hopkins UniversityPresented at the American Psychological Association Annual Meeting, Washington, D.C., August 16, 1992.     

Intensive case management for the seriously mentally ill

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

Residential caregiver attitudes toward seriously mentally ill persons

Previous research has found that caregiver attitudes are associated with the course of illness of seriously mentally ill (SMI) persons. This study examined whether variation in caregiver attitudes could be accounted for by (a) staff caregivers and/or (b) SMI persons. Group home staff were asked to describe each SMI group home resident and to describe the relationship they had with each resident. We recorded the number of positive and negative statements made by each staff member about each resident's character, behaviors, and the interactions staff had with them. Overall, the variation in positive staff statements about group home residents was significantly accounted for by the residents. In general, the variation in negative staff statements was significantly accounted for by staff. However, the variation in negative staff statements about the character of residents was accounted for by both staff and residents.     

The emerging problem of diabetes in the seriously mentally ill

We describe the increasing prevalence of chronic illnesses such as obesity and type 2 diabetes have markedly increased in both developed and developing countries. We describe the relationship between type 2 diabetes and mental illness. The extant literature suggests a critical need for innovative treatments targeted to individuals with comorbid diabetes and mental illness. Given the complexity and challenge of both of these disorders in tandem with the interactive challenges and burdens of psychiatric and medical comorbidity, it is essential that interventions address the issue of mental and medical health from the perspective of the individual with the disorder, engage individuals to actively participate in illness self-management, and include consideration of the multiple barriers to care.     

The interest of trainees in working with seriously mentally ill persons

Working with persons who have severe and persistent mental illness has generally not been a preferred career track for prospective mental health professionals. Most of the literature has focused on the recruitment of psychiatrists. This paper reports the results of 78 students in Rhode Island representing three allied mental health professions—social work, psychology, and nursing. Significant differences were found in training environments and learning activities, in interests in working with various diagnostic groups, and in rating the relative importance of both client problems as well as interventions strategies. Implications for future academic-mental health linkages are suggested.     

Hospital-based multidisciplinary training in the care of seriously mentally ill patients

A four-week training program at a state hospital in Virginia familiarized undergraduate and graduate students in medicine, occupational therapy, pharmacy, psychiatric nursing, psychology, and social work with the range of care for chronic mentally ill patients. Designed to improve the training of mental health professionals and recruit mental health professionals to work in public mental health settings, the program included lectures, group discussions, field trips to community-based treatment and rehabilitation facilities, and supervised clinical experiences. Students who participated in the program reported being less discouraged about working with chronic mentally ill patients and more likely to choose careers in public psychiatric settings.     

Developing community-based program alternatives for the seriously and persistently mentally ill elderly

The deinstitutionalization movement in the United States has traditionally neglected the rehabilitation potential of the seriously mentally ill elderly. With the proliferation of the elderly population, unique programs and community-based settings must be created and expanded to meet the mental health needs of this population in a cost-effective and humane manner. The mental health continuum presented is a model composed of programs that target the seriously mentally ill elderly in a variety of community placements including residential treatment facilities, nursing homes, retirement homes, and permanent housing.     

The seriously mentally ill: Another perspective on treatment resistance

There is a subpopulation of the seriously mentally ill who remain acute care recidivists, rarely becoming engaged in follow-up treatment. It has been argued that these individuals are system, rather than treatment resisters. The perceptions they have of their problems are often in conflict with staff evaluations, or with what the system has to offer. In the present study, patients who dropped out of residential care against staff's advice were compared to patients who remained in treatment. The results suggest that the greater the difference between the perceptions a patient and therapist have concerning the patient's problem, the greater the likelihood of the patient dropping out of treatment.Dr. Goldfinger is an Assistant Professor of Psychiatry, Harvard Medical School.     

Community care of the seriously mentally ill: Continuing problems and current issues

The crisis in community care for the seriously mentally ill (SMI) stems from organizational and financial difficulties as well as from deeply embedded structural factors. The analysis shows a preference for medicalizing and individualizing the problems of SMI rather than viewing them as structural social welfare issues. The author discusses problems of deinstitutionalization, homelessness, service provisions, financing, accounting and reporting, employment, bureaucratic skimming and burden to families and points out the ambivalent ideology and the inherent contradictions within the mental health service system. Finally, the centrality of social control and the maintenance of orderly social life in public, policy and program development is illuminated.Research for this article was supported in part by the Brookdale Fellowship Program of the Jewish Communal Fund of New York City. The author would like to acknowledge with thanks the assistance provided by Dr. Jeffrey Solomon, former Executive Vice President of Altro, Health and Rehabilitation Service, New York, NY. The author thanks David Mechanic, Leona Bachrach, Phyllis Solomon and Shirley Smoyak for their comments on an earlier draft of the paper. Thanks are due also to Gerald Grob whose editorial suggestions improved the final version of this paper.     

Economic barriers to widespread implementation of model programs for the seriously mentally ill

Although deinstitutionalization has been linked with an increase in the number of mentally ill people who are homeless or in jails, several demonstration programs started during the past 30 years have shown that community-based services for the seriously mentally ill can be both humane and cost-effective. Four such programs, none of which has been widely implemented or has significantly influenced service delivery systems, are described. The author contends that the chaotic and illogical funding system for mental health services is primarily responsible for failure of the widespread implementation of demonstrably effective programs. The economic disincentives of the present system include lack of coordination of services at the state and local level and federal policies that favor hospitalization, restrict payment for outpatient and rehabilitation services, and discourage mentally ill persons from working. The author suggests that public services for the mentally ill are unlikely to improve significantly until such disincentives are addressed.     

The cultural context of interventions for family members with a seriously mentally ill relative

This chapter provides an overview of interventions for relatives of severely mentally ill individuals. The author discusses the design and use of these interventions in the context of the cultural characteristics of families and providers, as well as the culture of the interventions themselves.