Hospital & community psychiatry
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The high readmission rates of discharged psychiatric patients have forced mental health professionals to play closer attention to aftercare planning. A program was developed at a psychiatric hospital in Ontario in 1977 to deal with "problem patients"--those who were deemed difficult to place in the community by the referral person or department. The program was characterized by shared institutional-community staffing, systematic aftercare assessment and planning, a crisis intervention approach to discharge, the use of a transitional staff member with patients, and the development of close relationships with community agencies. Study data show that the program was effective in limiting the number of readmissions during its first two years to 20 per cent.
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While psychiatry has been ambivalent about treating mentally ill offenders, recent mandates for better mental health care for prisoners will require the profession's intervention. The authors, whose study of mental health care needs of inmates in Oklahoma is reported in the article following this one, believe that because the prison is a community, a community-mental-health-like system offering a continuum of services is indicated. Some of the services they propose for prisons include outpatient and partial hospital services, an acute inpatient unit, a residential tertiary care unit, and an intermediate living unit. They also believe that mental health professionals should help improve the environment of prisons, and can do so by sharing lessons learned in their own institutional settings about the effects of a therapeutic community and a legitimate patient government.
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Litigation has been a successful strategy in securing rights for the mentally ill. After early victories, however, limits of litigation began to emerge; implementation of court orders raised many policy questions. The translation of broad rights into complex public policy has led directly to the legislative and administrative policy processes, as can be seen with the proposed Mental Health Systems Act. The author uses the evolution of Title 3, a rights and advocacy amendment of the proposed act, as a case study in the formation of public policy.
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Hosp Community Psychiatry · Jun 1980
Case ReportsHospitalization of a psychotic mother and her breast-feeding infant.
Although a nursing mother who becomes psychotic and requires hospitalization is traditionally separated from her infant, the authors successfully treated a psychotic mother by hospitalizing both mother and son. Staff members cared for the infant in the hospital nursing station and assisted the mother in understanding and caring for her son through a structured schedule of infant care. The early focus on the mother-child relationship hastened the recovery of the mother to no detriment of the child.