Families of chronically mentally ill people: siblings speak to social workers

Twenty siblings of chronically mentally ill people discussed their emotional responses to the mental illness of their brother or sister. The findings were drawn from a study that was part of the author's practice experience as a social worker in a community mental health setting. The findings also paralleled the author's life experiences as a sibling of a chronically mentally ill person. Sibling emotional responses were categorized into grief and loss phases of denial, anger, bargaining, depression, relief/respite, and acceptance. Siblings believed that their expressions of grief and loss were impaired by characteristics of mental illness and by mixed messages from the mental health system. The siblings recommended inclusion of siblings in client treatment; support and education for siblings; clear communication between social worker and family; a social worker focus on family strengths; and, most of all, effective client intervention. The sibling perspective points out the salient need for social workers to use their ecological, person-in-environment training to facilitate healthier family support networks for chronically mentally ill people.     

Supportive housing in Brooklyn

Since 1977, Saint Vincent Catholic Medical Centers of New York City has been creating and maintaining supportive housing offerings for at-risk populations, such as individuals with HIV/AIDS, those with substance abuse challenges, and the mentally ill. By providing a continuum of medical and social services, the organization aims to help residents stabilize and rebuild their lives. Saint Vincent sees empowerment as a key step toward helping individuals maintain their health, re-enter the community, seek employment, and pursue other goals. Some of the supportive services Saint Vincent offers in its housing communities are care coordination, counseling, peer support networks, self-help groups, leisure activities, help with finances, and referrals to community agencies offering other resources. Recognizing the importance of job training and assistance, the system also offers a unique program in which mentally ill individuals are able to work in a recycling center or office cleaning business, both of which are owned by Saint Vincent.     

Risks to mental health patients discharged into the community

The advances in pharmacological and psychosocial treatments in the 1950s and 1960s facilitated the movement of care for increasing numbers of mentally ill people from the institutions to the community. This represented a radical change in mental health strategy and practice and has brought with it new sets of risks. Due to inherent stigmatisation and some well publicised cases of violence and murder, there is a perceived risk to the public from community-based mentally ill people. The findings of many studies have illustrated this and have led to the isolation and rejection of large numbers of people who have mental health problems. This has increased the risk to mentally ill people of victimisation and harassment from members of the public. Kelly and McKenna (1997) have shown that this takes many forms and occurs within and outside the home. Most worrying these latter risks can increase the former where some mentally ill people carry weapons to protect themselves. This in turn can increase public fear and raise stigmatisation. Furthermore, the lack of support and belonging can increase the risk of self-harm among the mentally ill. A more general risk is that for many deinstitutionalisation simply means transinstitutionalisation where incarceration in large mental hospitals is being replaced by incarceration within community based houses and flats. To assuage these risks mentally ill people still require social support and protection. The asylum the place may have disappeared but asylum the function is still required.     

A point prevalence study of alcoholism and mental illness among downtown migrants

Since the 1960s the bulk of America's mentally ill have been deinstitutionalized to the community. A number of these people now live in the downtown areas of large cities in close association with the established vagrant culture which includes a significant portion of alcohol abusers. The bizarre and impoverished nature of the lives of these formerly institutionalized mentally ill citizens, coupled with their propinquity to government and business establishments, creates a social policy dilemma. A point prevalence study design was used to ascertain the demographic, physical, mental illness and alcohol abuse characteristics of a sample of a vagrant population which inhabits the downtown area of an American Northwest urban community. Analysis of the data of a sample of vagrants who frequent an emergency shelter and a single residence occupancy hotel demonstrated that the two groups were similar. Participants were predominantly male, white and in their mid thirties. Forty percent had never married and over 50% were high school educated and possess labor skills. Grouped data indicates that, in view of the dearth of literature describing the relationship of mentally illness and alcohol abuse, the psychiatric and alcohol use behavior of deinstitutionalized populations requires further study.     

The Effects of Alcohol Abuse Among the New Chronically Mentally Ill

In recent years, there has been a growing recongition of the high incidence of alcohol abuse among the new generation of chronically mentally ill. This article reports on a study that tracked a subgroup of the chronically mentally ill, those discharged from state psychiatric hospitals, through an entire community mental health aftercare system and its major auxiliary human service agencies. Those who were assessed by hospital discharge social workers as having a need for alcoholism services were found to be less likely to be referred for aftercare and to make contact with aftercare agencies post discharge; and for those with an alcoholism problem who do make contact, they generally received less service than those who did not have a need for alcoholism services. The professionals in both the mental health and alcholism fields need to work together to better meet the needs of the chronically mentally ill with an alcohol problem.     

The effects of alcohol abuse among the new chronically mentally ill

In recent years, there has been a growing recognition of the high incidence of alcohol abuse among the new generation of chronically mentally ill. This article reports on a study that tracked a subgroup of the chronically mentally ill, those discharged from state psychiatric hospitals, through an entire community mental health aftercare system and its major auxiliary human service agencies. Those who were assessed by hospital discharge social workers as having a need for alcoholism services were found to be less likely to be referred for aftercare and to make contact with aftercare agencies post discharge; and for those with an alcoholism problem who do make contact, they generally received less service than those who did not have a need for alcoholism services. The professionals in both the mental health and alcoholism fields need to work together to better meet the needs of the chronically mentally ill with an alcohol problem.     

Community care for people who are homeless and mentally ill

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.     

Consultation with community care facilities.

An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically mentally ill persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference with work efficiency are described by examining realistic conflict resolutions utilizing problem clarification, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.     

A study of the mentally ill in institutions for homeless people in Tokyo]

Homeless problems associated with poverty may be considered almost resolved in Japan because of the post World War II economic development, but in large cities such as Tokyo the homeless are still being produced, a reflection of a variety of social problems. This study is based on an analysis of admission records of an institution for the homeless which was established in 1952 in Tokyo. Subjects are 2,122 single persons who were admitted between 1952 and 1985. Among these, 136 are mentally ill persons, who are the main subjects of analysis in this study. Results show that, which after 1970 the number of the mentally ill significantly increased, many of those people dropped out of the institution mostly because they were originally admitted directly from discharge from hospitals because there was no other place to go except the institutions, and also because the institution, originally meant to house street people who had been detained, did not offer appropriate programs for the mentally ill. A solution to these problems requires that roles of institutions for the homeless and subjects admitted be reconsidered. Institution staff should enrich programs designed for the homeless mentally ill and help them organize their social network and live in the community.     

Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care.

OBJECTIVES. This study examined the costs of psychiatric treatment for seriously mentally ill people with comorbid substance abuse as compared with mentally ill people not abusing substances. METHODS. Three different sources of data were used to construct client-level files to compare the patterns of care and expenditures of 16,395 psychiatrically disabled Medicaid beneficiaries with and without substance abuse: Massachusetts Medicaid paid claims; Department of Mental Health state hospital inpatient record files; and community support service client tracking files. RESULTS. Psychiatrically disabled substance abusers had psychiatric treatment costs that were almost 60% higher than those of nonabusers. Most of the cost difference was the result of more acute psychiatric inpatient treatment. CONCLUSIONS. Although the public health and financial costs of high rates of comorbidity are obvious, the solutions to these problems are not. Numerous bureaucratic and social obstacles must be overcome before programs for those with dual diagnoses can be tested for clinical effectiveness.     

Deinstitutionalization: A microcosmic perspective

Changes have taken place in caring for chronic patients due to deinstitutionalization, and these changes have affected the services rendered by the community mental health centers. Statistical data on dehospitalized patients treated in a community mental health center located in the South Central Bronx are examined to determine trends in service utilization by these patients. Demographic characteristics of this population are also examined. Issues surounding treatment and rehabilitation of chronic mentally ill patients are critically explored and recommendations for changes in the care of the chronically mentally ill patient are offered.     

Health care practices and health status of the mentally ill in the community

The chronically mentally ill generally need a variety of social supports to maintain themselves in the community. This study assessed the health care practices and health status of community-based respondents to determine if the health care needs of this chronic population were being met. Although positive results were found, service gaps deserving of attention were also revealed.     

Working atmosphere,job satisfaction and individual characteristics of community mental health professionals in integrated care

Working requirements of community mental healthcare professionals in integrated care are complex. There is a lack of research concerning the relation of job satisfaction, working atmosphere and individual characteristics. For the current study, a survey evaluating job satisfaction and working atmosphere of mental healthcare professionals in integrated care was performed. About 321 community mental healthcare professionals were included in the survey; the response rate was 59.5%. The professional background of community mental healthcare professionals included nursing, social work and psychology. Community mental healthcare professionals reported the highest satisfaction with colleagues and the lowest satisfaction with income. Moreover, it could be shown that more responsibility, more recognition and more variety in job tasks lead to an increase of overall job satisfaction. Healthcare for mentally ill patients in the community setting is complex and requires well‐structured care with appropriate responsibilities within the team. A co‐operative relationship among colleagues as well as clearly defined responsibilities seem to be the key for the job satisfaction of community mental healthcare professionals in integrated care.     

Community support for the long-term mentally ill.

In attempting to meet the needs of the long term mentally ill, community support programs are often hampered by social, political and economic barriers, especially the lack of community support. This article describes the development of one community support program and the strategies used to deal with these obstacles. Through empowerment, education, community involvement and avoidance of duplication, the community has become a willing and active participant in the program, and the program has become an integral part of the community.     

Community Support for the Long-Term Mentally Ill

In attempting to meet the needs of the long term mentally ill, community support programs are often hampered by social, political and economic barriers, especially the lack of community support. This article describes the development of one community support program and the strategies used to deal with these obstacles. Through empowerment, education, community involvement and avoidance of duplication, the community has become a willing and active participant in the program, and the program has become an integral part of the community.     

The last resort? Bed and breakfast accommodation for mentally ill people in a seaside town

There have been few studies about the seaside hotel accommodation provided for mentally ill people in the United Kingdom, despite its extensive use. This paper reports the findings of a survey in Southend, which compared living conditions and residents in bed and breakfast accommodation with those in sheltered accommodation for mentally ill adults. The results show that the mentally ill residents of bed and breakfast accommodation were living in less attractive and less well maintained surroundings. They were not only more likely to have been recently discharged from a psychiatric unit, but also had less contact with the range of community mental health services. Residents in bed and breakfast accommodation were, however, closer to local amenities, such as day centres and parks, than the control group. Staff practices were less restrictive in bed and breakfast accommodation than in the majority of sheltered homes; homes employing psychiatric nurses allowed residents the most freedom. These findings support the need for more accommodation of an acceptable standard for those people discharged from psychiatric units. Local liaison schemes between health workers responsible for the continuing care of mentally ill people and the landlords of bed and breakfast accommodation could improve the quality of life for these residents.     

Brown versus New York: the Rashomon of delivering mental health services in the 1990s.

This article examines a case study of one homeless mentally ill woman in New York City to show the differing perspectives on mental illness among mental health consumers, family members, mental health professionals, and advocates. Different issues emerge, and different priorities for care become clear. The social worker as case manager must design intervention strategies based on these differing perspectives, a crucial challenge for the profession. This article reviews the current literature on case management and suggests a holistic approach that better meets the needs of mentally ill people, their family members, and the community.     

CONSULTATION WITH COMMUNITY CARE FACILITIES

An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically ill mental persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference and work efficiency are described by examining realistic conflict resolutions utilizing problem clarificaiton, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.     

Sociopsychiatric care as a municipal problem

Because of their disease mentally ill persons are often unable to request and receive necessary help on their own. Hence, local authorities have the legal duty to offer support in subsidiary or complementary ways or to organize help together with other participants concerned with psychiatric care. If the transition from community care to the differently structured regular health care system is too fast there is a danger of worsening of the symptoms. In the city of Bochum health insurance bodies agreed to take over the costs of therapy for mentally ill people via the sociopsychiatric services within the scope of crisis intervention. Background information on the sociopsychiatric services of the city of Bochum is given.