The Process of Group Treatment with the Chronically Mentally Ill

Group treatment has been used with inpatient psychiatric clients for numerous years. Only since the advent of deinstitutionalization have outpatient services begun to utilize this format. Over the ears, mental health professionals have realized that traditional talk therapy approaches do not adequately address the multiple, pressing needs resented by the person with chronic mental illness. A multi-modalry approach that utilizes case management, medication, family support, and group therapy has evolved. Specifically, activity focused group therapy has been recognized as an integral treatment modality. The author presents a model of group treatment and process which underscores the value of Occupational Therapy's contribution to the treatment of the chronically mentally ill.     

Method of Suicide in the Mentally Ill: A National Clinical Survey

Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self‐poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.     

病耻感对于精神病患者的影响以及文化对策

本文分析三种类型歧视所造成的患者及其家属的痛耻感,论述我们应当如何利用适当的文化应对策略来消除歧视、减少病耻感,从而有效地克服病耻感对于患者及其家属的负面影响。文化差异与病耻感的形成直接相关,文化作为一个重要变量,影响着精神卫生问题以及相应的服务政策,深入研究和认识儒家文化的核心价值有助于减少对于精神病患者的歧视,帮助他们克服病耻感。中国道家文化推崇道法自然,无为而治,可以发展出有效的心理疗法,对于精神疾病是一剂对症的良药。     

Dialectical Behavior Therapy Adapted for the Vocational Rehabilitation of Significantly Disabled Mentally Ill Adults

Twelve vocational rehabilitation clients with severe mental illness received a comprehensive adaptation of dialectical behavior therapy (DBT) delivered in a group format. Treatment consisted of 2 hours of standard DBT skills training per week and 90 minutes of diary card review, chain analysis, and behavioral rehearsal. Participants were selected based on previous failure to obtain or maintain employment. The participants had a mean of 3 psychiatric diagnoses each, and all participants met criteria for a personality disorder, with 58.3% having a diagnosis of borderline personality disorder. There were 4 dropouts and 8 treatment completers. The treatment completers improved significantly and maintained their improvements (at 6-month follow-up) in depression, hopelessness, and the experience of anger. In addition, the completers improved significantly from pretreatment to 6 months follow-up on anger expression, control of anger expression, work role satisfaction, and on number of hours worked weekly.     

Inner Night and Inner Light: A Quaker Model of Pastoral Care for the Mentally Ill

The same theological principles that motivated Quakers in institutional reform work continue to influence uniquely Quaker approaches to pastoral care for the mentally ill today. This unity of psychological and spiritual care, inspired by George Fox, was first apparent in the work of the Religious Society of Friends asylum reforms in the nineteenth century. These principles matured during the early twentieth century as they entered into dialogue with Jung and Jungian psychology and continue to inspire Quaker pastoral care models today. This paper will examine how theological concepts affect the way Friends approach mental health care, historically and in contemporary times.     

The Program Environment Scale: Assessing Client Perceptions of Community-Based Programs for the Severely Mentally Ill

The Program Environment Scale (PES) was developed for use with clients of community-based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their quality of life in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff-client and client-client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff-client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.     

Mechanical Chair Massage and Stress Reduction in the Seriously Mentally Ill Consumer: A Preliminary Investigation

In the present study, the authors evaluate the effectiveness of a mechanical massage chair in reducing stress for people with serious and persistent mental illness. This preliminary investigation involves the use of massage therapy for 19 people with serious mental illness, using a standardized massage protocol. Stress levels were assessed using a 7-point Likert scale, administered before and after each treatment session. Self-reported stress was found to be significantly reduced, with participants reporting an average stress reduction of 1.48. This preliminary investigation demonstrates that use of a mechanical massage chair can significantly reduce self-identified stress levels in persons with serious mental illness.     

Oregon's Gun Relief Program for Adjudicated Mentally Ill Persons: The Psychiatric Security Review Board

This article describes the State of Oregon's implementation of two programs designed to comply with federal gun laws regarding reporting individuals who have received mental health adjudications in criminal and civil courts. One mandate requires that states submit names of adjudicated individuals to the National Instant Criminal Background Check System (NICS) while the second requires that the state establish a qualifying gun restoration program for those disqualified from gun ownership. In 2009, Oregon's Legislature developed an administrative approach to gun restoration and assigned the responsibility for conducting these hearing to the Oregon Psychiatric Security Review Board (PSRB). The PSRB is a state administrative board that has existed since 1977 and has been primarily focused on the supervision and treatment of adult and juvenile insanity acquittees. The gun restoration program began in 2010, but to date has only received three completed petitions requesting restoration of firearm rights. The article concludes with a discussion that surmises why very few of the Oregonians who are listed in NICS have submitted petitions for relief. Copyright © 2015 John Wiley & Sons, Ltd.     

Children of Mentally Ill Parents Participating in Preventive Support Groups: Parental Diagnoses and Child Risk

In the Netherlands, preventive support groups are offered to children of mentally ill parents. Given the variety of parental diagnoses it might be questionable if offering a standardized program for all these children is the most effective response. While no overall knowledge exists about the type of parental disorder and varying risk levels and support needs among the participating children, we examined whether there are differences between these children that are related to their parents’ diagnoses. With questionnaires we assessed risk factors in 122 mentally ill parents and their children: high parental illness severity, low perceived parental competence, parent–child interaction problems, poor family functioning, difficult child temperament, and low child competence. We also assessed the children’s psychosocial problems and negative cognitions about their parent’s illness. Results showed that most parents had co-morbidity (multiple diagnoses) and/or personality disorders. Children of parents with either of these conditions were more likely to be exposed to the risk factors: high parental illness severity, low perceived parental competence, problematic parent–child interaction, and low perceived child competence, compared to children of parents without these conditions. They were also faced with more risk factors and had more psychosocial problems and negative cognitions. From these results we may conclude that children of parents with co-morbidity and/or personality disorders require more extensive support than children of parents without these conditions. We suggest strengthening the children’s competence and involving parents as important focuses of preventive interventions for children at high risk. Longitudinal studies should test these assumptions.     

Willingness of Mentally Ill Individuals to Sign Up for a Novel Proposal to Prevent Firearm Suicide

The study goal was to determine whether a significant number of high suicide risk individuals would confidentially put their own names onto a list to prevent future gun purchases. An anonymous written survey was administered in an inpatient psychiatric unit and two outpatient psychiatric clinics at an academic medical center. Two hundred forty individuals were approached to fill out the survey, of whom 200 (83.3%) did so. Forty‐six percent of participants stated that they would put their own name onto the list. This novel suicide prevention proposal, a Do‐Not‐Sell List, would appeal to many people at high risk for suicide.     

Selection Criteria for a Career Development Program for the Mentally Ill: Evaluation of the Self-Directed Search (SDS)

Criteria were developed for the selection of a career development program appropriate for the mentally ill. The criteria were based on the Career Development Curriculum (CDC) for the mentally ill and the Purdue Stepped Approach Model. The Self-Directed Search (SDS) was chosen as a program because it met all the selection criteria. Mentally ill program participants showed a significant change (p<.035) on the My Vocational Situation Identity Scale. The findings support the selection of the SDS as a program and the feasibility of offering career development services to mentally ill clients.     

From the Couch to the Street: Applications of Psychoanalysis to Work with Individuals Who Are Homeless and Mentally Ill

Current-day psychiatric treatment of severely disturbed populations tends to focus on the biological, behavioral, and social dimensions of rehabilitation. This paper addresses the relative neglect of the complex psychodynamic and interpersonal aspects of treatment of individuals who are homeless and mentally ill by presenting two clinical cases that are discussed from various psychoanalytic frames of reference. Based on their clinical experiences, the authors conclude that psychoanalysis offers valuable frameworks to guide the treatment process and the structure of the treatment setting for individuals who are homeless and suffering from severe psychiatric illness.     

The Irrationality of Physicalism

This paper argues, not that physicalism is wrong, but that it is irrational. The paper defines standards of rationality, both metaphysical and epistemological, that physicalism necessarily inherits from science. Then it assesses physicalist efforts to naturalize consciousness in light of these. It concludes that physicalism allows its metaphysics to outrun its epistemology, in defiance of applicable standards, revealing a fundamental incoherence in the doctrine. The paper also briefly reviews other naturalization programs, to claim that physicalism, unlike the sciences, hasn’t proved fruitful.     

The Context of Caretaking in Rural Areas: Family Factors Influencing the Level of Functioning of Seriously Mentally Ill Patients Living at Home

After the deinstitutionalization of psychiatric hospitals, many families became primary caregivers for seriously mentally ill individuals. Mental health services became further reduced with the advent of managed care and reductions in health and mental health care. The dearth of community-care options often results in psychiatric patients being quickly stabilized in hospital units and discharged to live with their families. The lack of community resources is particularly acute in rural areas. Given these realities the current study sought to determine if family caretaking variables are related to patient outcomes. Family factors including the perception of burden, expressed emotion (EE), and primary caregivers’ social support were tested in a model of caretaking that examines the relationship between these factors and patients’ symptom expression and social and occupational functioning. The sample includes 49 predominantly African American families living in a rural area and with a chronically ill family member who had been previously diagnosed with a psychotic disorder. Primary caregivers and patients were interviewed using adapted measures of burden, EE, and social support. Patients were administered a revised version of the Brief Psychiatric Rating Scale. Results suggest less perceived burden, increased caregiver support and, to a lesser extent, EE explain approximately one-fifth of the variance in patient functioning. These results support previous research demonstrating the importance of family factors for seriously mentally ill patient outcomes. Results are discussed in terms of implications for assisting families in the current era of diminished resources.     

Irrationality profiles for anger and anxiety

A fundamental position in Rational-Emotive Therapy (RET) is that irrational belief systems cause emotional disturbance. This study adds to the body of recent research substantiating this position by showing significantly different profiles on the Jones Irrational Beliefs Test (IBT) (1968/1969) for a nonclinical population (N=446) differentiated according to low, medium, and high anxiety and low, medium, and high anger. The profile differences not only support the above fundamental position, but also offer some further evidence for the validity of the IBT.Paul J. Woods, Ph.D., co-editor of this journal, is an associate fellow of the Institute for Rational-Emotive Therapy, a professor of psychology at Hollins College, and is engaged in private practice in Roanoke, Virginia.Samuel K. Coggin is completing his Master's work at Hollins College and is employed as a psychologist at the Central Virginia Training Center, Lynchburg, Virginia.