State mental hospitals and the future

There seems to be a general acceptance of the idea that at some future date mental hospitals will disappear to be replaced by community mental health services of various kinds. The author points out that remarkably little interest is focused on the possibility of a new model of residential care to replace the outmoded hospital. Some form of residential mental health care will probably always be needed, and should be complementary to the developing nonresidential services. A strategy for revitalizing mental hospitals is outlined.Dr. Jones is in private consulting practice at 5911 East Calle Del Paisano, Phoenix, Arizona, 85018, and is a part-time consultant to Arizona State Hospital.     

Child abuse rating system for archival information in severe mental illness

Background

Assessing and addressing child abuse histories are one of the grand challenges in psychiatric rehabilitation. Archival information, e.g., comprehensive psychosocial evaluations, objective testing, court documents, and medical chart information can provide useful and objective historical accounts. It is essential to develop a reliable and valid child abuse rating system for archival information.

Purpose and methods

This study aimed to examine the reliability and predictive validity of a highly structured and specific child abuse rating system used to code archival information for 150 psychiatric inpatients with severe mental illness (SMI).

Results

The child abuse rating system produced reliable ratings across raters and subtypes of child abuse were highly inter-related. More than half (56.5%) of the sample with SMI was identified to have one or more types of child abuse history; specifically, child sexual abuse (CSA, 36%), child physical abuse (CPA, 27.3%), emotional maltreatment (EM, 36%), failure to provide (FTP, 10.7%), and lack of supervision (LOS, 32%). Female participants (50%) with SMI had higher rates of CSA than male participants (20.8%). Subtypes of child abuse history were related to poorer premorbid functioning, but the relationships varied across different types of child abuse. In addition, CSA and EM were related to greater suspiciousness/hostility.

Conclusion

The child abuse rating system for archival data fills an important gap in existing methodology and, in conjunction with a self-report measure, is expected to improve the assessment and understanding of the prevalence of child abuse among adults with SMI. Potential limitations and recommendations for future research are discussed.