Higher education and psychiatric disabilities: national survey of campus disability services

Students with psychiatric disabilities are an increasing presence on college and university campuses. However, there is little factual information about the services available to these students in campus disability services offices or the extent to which they use these services. This article reports the results of a survey of disability services offices at colleges and universities in 10 states. Data from 275 schools revealed the number of students with psychiatric disabilities seeking assistance from disability services offices, characteristics of these offices, and the types of services they provide. Survey data also identified barriers to full participation of these students in academic settings. Implications of the study are discussed to inform policy and postsecondary institutional practices with the goal of better serving psychiatrically disabled students to maximize their talents and potential.     

Connectedness and citizenship: redefining social integration

OBJECTIVE: Despite decades of deinstitutionalization, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it. To effectively address the persisting problem of social exclusion of persons with psychiatric disabilities, new conceptual tools are needed. To address this need, a new definition of social integration is offered. METHODS: The definition is based on data from a qualitative study. Data collection consisted of individual, unstructured interviews with 56 adults who have been psychiatrically disabled (N=78 interviews) as well as ethnographic visits to five service sites working to promote social integration for their users (N=8 visits). An interpretive approach was used to analyze the data. RESULTS: Social integration is defined as a process, unfolding over time, through which individuals who have been psychiatrically disabled increasingly develop and exercise their capacities for connectedness and citizenship. Connectedness denotes the construction and successful maintenance of reciprocal interpersonal relationships. Social, moral, and emotional competencies are required to sustain connectedness. Citizenship refers to the rights and privileges enjoyed by members of a democratic society and to the responsibilities these rights engender. The definition calls for full rights and responsibilities of citizenship. CONCLUSIONS: The new definition sets an ideal, but not unrealistic, standard for social integration in the context of psychiatric disability. High standards encourage mental health professionals and policy makers to rethink what is possible for mental health services and to raise expectations for connectedness and citizenship among persons once disabled by mental illness.     

Who will treat psychiatrically disturbed developmentally disabled patients? A health care nightmare

The authors assess the impact of a policy adopted briefly in New York State to facilitate short-term hospitalization and long-term aftercare of psychiatrically disturbed, developmentally disabled patients. Denied admission to New York State facilities that provide long-term care for the psychiatrically disturbed or the developmentally disabled, these dually diagnosed patients have often languished in the emergency room of municipal hospitals or been inappropriately hospitalized in the acute-care psychiatric unit, sometimes for several months. The authors conclude that the policy expedited hospitalization but failed to facilitate patients' discharge because it did not address the underlying need for suitable aftercare facilities. Overlapping clinical and administrative issues and political exigencies that complicated the policymaking process are discussed.     

The closure of a major psychiatric hospital: can psychiatric patients in long-term care be integrated into existing nursing homes?

Nursing homes are important alternatives to large hospitals when psychiatrically ill patients are relocated in the community, but their suitability for this type of patient is being questioned. This study compared patients in two traditional Swedish nursing homes (n = 66) and patients in long-term care at a large psychiatric hospital (n = 106). The results showed that both types of institutions housed patients with organic dementia and psychiatric symptoms. The hospitalized demented patients, however, displayed significantly more cognitive impairment, more confusion, and more behavioral disturbances than the nursing home patients. Significant differences were also found between the nursing home patients and hospitalized psychiatrically ill patients without dementia. The latter were younger, had better activities of daily living capacity, but displayed more psychiatric symptoms and behavioral disturbances than the nursing home patients. We concluded that all the patients in long-term psychiatric care will require sheltered accommodation. The demented patients could possibly be integrated into nursing homes, but successful integration would require special arrangements. Psychogeriatric units with staff qualified to care for patients with severe behavioral disturbances would be preferable. It would not be possible to meet the psychiatrically ill patients' special need of care in existing nursing homes. Alternative living arrangements, with care given by staff trained in psychiatry, are recommended.     

Employment equity and mental disability

PURPOSE OF REVIEW: Recent research on the civil rights issue of employment equity for people with psychiatric disabilities is reviewed. RECENT FINDINGS: Mental disorders, particularly depression, are the most frequent source of occupational disability worldwide and are expected to grow. Employers are increasingly aware of the productivity costs associated with mental disorders and the importance of fostering a mentally healthy workforce. Few firms, however, have explicit policies to include disabled people in their workforce, and many employers continue to express prejudicial views toward people with mental disabilities which would exclude them from competitive work. At the same time, disability legislation has not offered the hoped-for protection for people with mental disorders. Employers have expressed concerns over the costs of making workplace accommodations and have successfully battled for a legal definition of disability that excludes many individuals with mental disorders. CONCLUSION: In the absence of antistigma efforts directed toward the business community, one wonders if the growing awareness of the productivity costs associated with mental disability will foster greater employment equity, or fuel more subtle forms of employment discrimination. Low employment levels among people with disabilities remain a major determinant of the social disparities they face.     

Hospitalized children of substance-abusing parents and physically and sexually abused children: a comparison.

The symptoms and diagnoses of 58 psychiatrically hospitalized children aged 12 or under who were children of substance abusing parents (COSAPs) were compared with a matched group of 51 children who were not COSAPs. These two groups were further subdivided according to history or lack of history of physical and/or sexual abuse. Symptoms and diagnoses of COSAPs and physically and/or sexually abused (P/SAs) children differed significantly from the hospitalized group who were neither COSAPs nor P/SAs. Being a COSAP and/or P/SA are strong correlates of psychiatric hospitalization for the children studied. Both high-risk groups should be awarded special diagnostic and treatment consideration that would include their systematic identification and focused treatment.     

The tip of the iceberg: psychiatric consultations on an orthopedic service

One hundred and one consecutively admitted orthopedic patients with leg fractures participated in a study assessing psychiatric morbidity using the BSI- and SMAST-questionnaires. Patients identified as probable cases of psychopathology were then psychiatrically evaluated to establish diagnoses. It was determined that about 70 percent of the sample met the criteria for psychiatric diagnoses, with substance abuse being the leading group of disorders. The psychiatric consultation-liaison and orthopedic services remained blind to the research activities and continued to refer patients for psychiatric consultation when clinically necessary. Only six (5.9%) of the patients also participating in the study were referred for clinical consultation, and these appeared to have very obvious symptoms or complaints. The large majority of emotional distress remained unnoticed.     

Post-Traumatic Stress Disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake,Kobe, 1995)

The Hanshin-Awaji Earthquake of 1995 and has moved through the various phases into the recovery stage. After the earthquake we conducted two surveys involving approximately 8000 families with pre-school aged children and 466 families with disabled children. Symptoms related to PTSD were found more frequently in the small children whose houses had been severely damaged one year after the earthquake. Although the symptoms decreased, they were still present more frequently in the children and their mothers with severely damaged homes in 1998. Our results show children with intellectual or emotional disabilities displayed many behavioral problems. The physically disabled children required medical resources and specialized support in a structured environment. Both groups voiced the need to set up specialized facilities for people with disabilities. Following the Central Java Earthquake in 2006, we have engaged in “children house” activities in the disaster stricken area in collaboration with Gadjah Mada University. Through this activity, we have been able to share what works in helping children with disabilities and their families. From our experience we have found exchanging of information among the people in the disaster stricken areas helps to reduce the psychological damage of the children and aids in their recovery process.     

Outreach and peer-delivered mental health services in New York City following September 11, 2001

OBJECTIVE: Following the tragedy of September 11, 2001, the Federal Emergency Management Agency (FEMA) funded Project Liberty, an umbrella program operating from multiple sites throughout New York City to provide free crisis counseling and other assistance. One particular Project Liberty site provided peer support services for individuals with pre-existing psychiatric disabilities. This article reports on the outreach efforts undertaken by Project Liberty's Peer Initiative. METHODS: As part of a broader qualitative study, face to face interviews were conducted with Project Liberty Peer Initiative staff and service recipients. CONCLUSIONS: Outreach was found to be a key strategy used to identify and connect with psychiatrically disabled individuals in need after disasters. Implications for the use of similar outreach strategies in future disaster planning and service delivery are described.     

Investigation of the validity of the algorithm for evaluating the degree of disability in those who are institutionalized in long-term psychiatric care facilities in Hiroshima]

The Disability Support Act is intended to integrate welfare services for those who are physically, intellectually, or mentally disabled and promote the independence and social participation. However, the Act has been the center of intense controversy since its implementation in 2005. A number of important issues on implementing the Act in psychiatric medicine have been raised, and the validity of the for evaluating algorithm the degree of disability in those who are mentally disabled is considered to be of the utmost importance. We investigated the validity of the algorithm for evaluating the degree of disability in 2,200 patients who were institutionalized in long-term psychiatric care facilities in Hiroshima. The discordance rate between the primary evaluation by computer program and secondary evaluation by specialists' review was 50.9%. A wide disparity in evaluating the degree of disability was observed between that by secondary evaluation by specialists' review and that by evaluation of IADL. This disparity was more prominent in those who were more severely disabled. Further studies are needed to develop a new evaluation method to address the psychiatric signs and symptoms, and cognitive deficit of the mentally disabled.     

A rehabilitation response to the call for asylum

Recently, the Schizophrenia Bulletin published an article on the concept of "asylum" for the mentally ill (Wasow 1986). This concept of asylum, while based on a desire to protect people with psychiatric disabilities is too vague to be useful and is politically dangerous. As a response to currently inadequate community service systems, it fails to take into account the empirical evidence of effectiveness of community support and rehabilitation programs and ignores the larger social responsibility to provide stable housing, employment, and other necessities to these individuals. Finally, it conflicts with the desires of psychiatrically disabled persons themselves. There is a need for aggressive development of community support and rehabilitation services, greater attention to the stated desires of mental health consumers, and continuing research into program effectiveness.     

Psychiatric leisure rehabilitation: conceptualization and illustration

Leisure or recreational rehabilitation is not much developed in psychiatric rehabilitation. I present some definitions and a (very) brief history of the notion of leisure, as well as the role of leisure in health. I then describe a novel classification of leisure activities relevant to people with psychiatric disabilities. Following that, I conceptualize the process of psychiatric leisure rehabilitation, illustrated by a case study. I conclude with the benefits of psychiatric leisure rehabilitation and with suggestions for further study and development in this field. Leisure or recreational activities are central in modern life. Not so for persons who have serious and disabling mental disorders. This is manifest even in psychiatric rehabilitation, which mostly addresses vocational and residential--rather than leisure--environments (Anthony, Cohen, Farkas & Gagne, 2002; Corrigan, 2003). Yet leisure is important for persons with psychiatric disabilities, perhaps especially so for those who are not successful or satisfied in vocational environments. This paper outlines a conceptual framework for psychiatric leisure rehabilitation, based on a novel classification of leisure activities, and illustrates this with a case vignette. But first, some definitions and a (very) brief history of the notion of leisure is in order, as well as a presentation of facts about the role of leisure in health (physical and mental).     

Stories of the silent: advocating for a disabled woman at end of life

Carol's story is one of a disabled woman who, after living in her home for 10 years with the assistance of paid providers, is hospitalized in an acute care facility for surgery. Postoperative delirium and confusion cause Carol to lose decision-making capacity for a short time; even when her mental clarity returns, Carol is subject to disability bias, possibly unconscious, by health care providers who are persuaded to listen to her psychiatrically impaired son. The case study demonstrates that patients with disabilities in the acute care hospital environment need health care providers and ethics consultants who are open to learning their story and incorporate their wishes into a plan of care that supports their dignity.     

Quality of life in alternative residential settings

Central to policy revisions over the past forty years toward persons with psychiatric disabilities has been a change in where they live. Whereas forty years ago those patients needing assistance were generally housed in large public mental hospitals, today a myriad of alternative community housing settings are offered. A major impetus for this shift in housing, at least as currently articulated in most public forums, has been to improve their quality of life. Here we examine the quality of life experiences of psychiatrically disabled persons living in alternative settings: a state hospital, large residential care facilities, small group homes, and supervised apartments. Our central hypothesis, only partly supported, is that a quality of life gradient exists across these living settings. The results lend support to the value of quality of life assessments and point to the importance of more focused notions about how our various interventions may affect the persons whom we serve.     

What affects self-esteem of persons with psychiatric disabilities: the role of causal attributions of mental illnesses

This study addresses the factors which affect the self-esteem of persons with psychiatric disabilities, with a specific focus on the role of causal attributions of mental illnesses. It is based on data collected from 461 persons with psychiatric disabilities (consumers) served through psychiatric rehabilitation agencies. The results of regression analyses revealed that household income, diagnosis, psychiatric symptoms, service satisfaction, perceived stigma, and perceptions of social roles were all related to self-esteem. Consumers' causal attributions did not have direct effects on self-esteem, but the effects of causal attributions on self-esteem were moderated by psychiatric symptoms and by perceptions of social roles, suggesting that self-esteem enhancement strategies should be tailored to consumers' psychiatric and cognitive characteristics.     

The interrupted career group: a preliminary report.

This paper reports on the Interrupted Career Group, a therapy group for individuals whose professional and personal lives have drastically changed due to psychiatric illness and whose attempts to resume a career or other meaningful activities have been unsuccessful. Thirty-two persons with interrupted careers were asked to specify and pursue a vocational, educational, or volunteer track that integrated previous skills and activities with their present life situation and psychiatric limitations. They were also encouraged to discuss feelings of envy, shame, inferiority, rage, and humiliation associated with their interruption or activated in their new pursuits. Twenty-two of the participants effected change by utilizing the group to discuss feelings and efforts connected to resuming an integrated track. Such changes were seen equally in vocational/educational/volunteer activities and emotional functioning, or more in emotional functioning than in vocational/educational/volunteer activities. Ten participants did not show change; they were too psychiatrically disabled, lacked adequate motivation, or were unable to process affects related to actual pursuit of changes and integration. An interactive group process focusing on feelings of shame, envy, rage, inferiority, and humiliation related to experiences of an interrupted career can contribute to improved emotional and vocational functioning.     

Psychiatric adolescent inpatients: eight- to ten-year follow-up.

Seventy-seven adolescent psychiatric inpatients, whose index hospitalization was at a mean age of 16, were followed up for eight to ten years after discharge. The important findings at follow-up were as follows. Twelve patients had bipolar affective disorder and were severely disabled (of these, 11 had a long-term clinical course and three committed suicide). Sixteen patients had unipolar depression: five had one depressive episode and were well throughout the follow-up period, one patient had many episodes with complete remissions, and the remaining ten patients had only partial remissions and their impairment of functioning corresponded to the severity of their symptoms. One of the ten committed suicide. Eighteen (23%) patients were psychiatrically well and functioned adequately throughout the follow-up period. Five had primary depressions, five had undiagnosed psychiatric illness, and eight were diagnosed as not having a psychiatric disorder.     

Freud on play, games, and sports fanaticism

Much has been written in the secondary literature on Freud's aggression-release perspective vis-à-vis competitive sports. Very little has been written, however, on Freud's own explicit contribution to play, games, and sport. That is likely the result of Freud's reluctance to take up them--especially from the gamesman's and sportsman's points of view. One can, however, tease out the development of Freud's thoughts on games, play, and sport through a careful examination of his corpus over time. In doing so, one finds an early view of play and games, where the drives behind those activities are self- and other-preservative, and a later view, where Freud introduces his death drive. The article ends with some notions on what Freud might have said on the fanaticism that accompanies competitive sport, had he expressly taken up the issue.     

Differential attitudes of Chinese students toward people with disabilities: a cross-cultural perspective

The purpose of this study was to examine the attitudes of 338 Chinese secondary school students toward three major disability groups (people who are physically disabled, emotionally disturbed, and mentally retarded) using an adaptation of the American Scale of Attitudes toward Disabled Persons (SADP). We found that physically disabled persons were rated higher across the three subscales of the SADP compared to either emotionally disturbed and mentally retarded individuals, who were rated similarly low by the students. The lack of differentiation between the two mental handicapping conditions is at variance with contemporary western findings. The overall negative attitudes toward people with mental disabilities may have significant implications for community rehabilitation programming for this population.     

The politics of normalization.

The concept of normalization is an influential paradigm in mental health. However, little attention has been paid to how the psychiatrically disabled fare in the competition for generic services. Four psychiatric aftercare areas were examined: income maintenance, housing, vocational-educational, social-recreational. Results indicate that generic services do not successfully support the chronic patient in three of the four areas examined. Only in the field of vocational-educational support have generic agencies made a serious effort, and even here the most seriously disabled patients still rely on specialized services. The authors suggest that the theory of normalization is constructed on fundamentally erroneous assumptions and discuss alternative rather than normative programs for the long-term mentally ill.