Community treatment for the seriously mentally ill: Is this community psychology?

Community treatment for seriously mentally ill individuals fits well into the philosophy of community psychology. Community psychologists have skills and experiences with other populations that represent assets in improving the ACT service model and producing richer and more useful research results for the future. Maybe we should ask ourselves why community psychologists have obviously avoided this intervention area and the population of seriously mentally ill individuals. Does this represent an adolescent reaction to the parent discipline — clinical psychology? Is the label “mentally ill” as stigmatizing to community psychologists as it is to the general population? Are these individuals written off as not worthy of or capable of benefiting from preventive interventions? Advocates for the seriously mentally ill are mounting a backlash against prevention services. We would be well advised at this time to become involved in community treatment and demonstrate that community psychology is forall vulnerable and at-risk population groups. If the truth of the matter is that “community psychology is not doing much of a job of empowering people” (Berkowitz, 1990), maybe the truth of the matter is also that we need to reach out to more disenfranchised populations with research to show that community psychologycan do the job of empowering some.     

TRANSITIONAL EMPLOYMENT FOR THE CHRONICALLY MENTALLY ILL

This article discusses the use of transitional employment in the vocational and psychosocial rehabilitation of the chronically mentally ill. The development and implementation of a transitional employment program at Towne House Creative Living Center, Oakland, California, is described. The value of adapting the work environment and use of support groups in aiding psychosocial and vocational adjustment are discussed. It is concluded that transitional employment is an effective treatment modality that can be utilized by occupational therapists involved in community based treatment of the mentally ill.     

Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.     

The Effects of Time Pressure on Controlling Reactions to Persons With Mental Illness

Population surveys suggest that the general public stigmatizes persons with mental illness less than in the past. However, implicit attitude measures find that immediate reactions to mentally ill persons are still negative among both the general public and people diagnosed with mental illness. Time-course data suggest that these reactions may be dynamic, with immediate negative reactions becoming less prejudicial over time. We manipulated time pressures imposed upon social judgments about a mentally ill person. Participants perceived a mentally ill person as dangerous when forced to respond quickly; participants given ample time to respond were less likely to have this perception.     

Addressing the Challenge of Community Reentry Among Released Inmates with Serious Mental Illness

The purpose of the paper is to discuss the formidable challenges to community reentry and reintegration faced by U.S. prison inmates with serious mental illness and to describe various strategies for improving transitional services for these individuals. We review epidemiologic data supporting the high prevalence of severe mental illness in U.S. prisons as well as the historical factors underlying the criminalization of the mentally ill. The importance and challenges of providing adequate psychiatric care for mentally ill prisoners during their incarceration are discussed. We also review the numerous psychosocial and economic challenges confronting these individuals upon their release from prison, such as unemployment and vulnerability to homelessness, as well as specific barriers they may encounter in attempting to access community-based mental health services. We follow with a discussion of some of the more promising strategies for improving the transition of the mentally ill from prison to the community. In the final sections, we review the evidence for a relationship between serious mental illness and recidivism and briefly discuss emerging alternatives to incarceration of the mentally ill.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Rotting with their rights on: why the criteria for ending commitment or restraint of liberty need not be the same as the criteria for initiating commitment or restraint of liberty, and how the restraint may sometimes justifiably continue after its prerequisites are no longer satisfied

That coerced treatment must end when the criteria for initiating coerced treatment cease to apply appears to be universally accepted by courts and commentators.2 Moreover, the consensus appears to be justified by a steel-trap argument. If coercion is justified only when the patient is mentally ill and incapable, because then the patient lacks autonomous capacities, or lacks practical reasoning abilities that undercut autonomous capacities, then these justifications have no force when the patient either is not mentally ill or is capable. A parallel claim holds for civil commitment. This received wisdom, or in = out thesis, rests upon a conceptual confusion: a failure to distinguish the criteria for initiation of intervention, those for cessation of intervention, and the purpose of the commitment or coerced treatment. If the criteria for commitment were mental illness and dangerousness, and the criteria for release were the same, then the purpose of commitment would be to restore persons to the point where they are either just barely not mentally ill, or just barely not dangerous. That is a silly and self-defeating purpose for that large class of patients who, because of lack of insight, or otherwise, do not become treatment compliant until they are substantially healthier than being barely not mentally ill or barely not dangerous. It sets them up to become revolving-door patients. The purpose of commitment is rather to maximize the patient's mental health, and minimize her dangerousness without unduly burdening her liberty. If society is going to violate a patient's liberty, it should do so in a way that will resolve the problem that justified the restriction on liberty in the first place, so long as the restriction of liberty is not too great in relation to the expected gains from the intervention. The criteria for releasing a patient from commitment are in this way responsive to the purpose of the commitment. For some revolving-door patients, this entails that the criteria for their release from commitment should be stricter than the criteria for initiating commitment in the first place. The criteria for release from commitment for revolving-door patients should be that the criteria for initiation for commitment is not met plus it being more likely than not that the patient will be treatment compliant after release, assuming the additional restriction on liberty is less than the gains from the additional restraint, and the restriction is not unduly burdensome. Spelling this out, the criteria for release should be either not mentally ill, or else not dangerous, or capable, and more likely than not to be treatment compliant after release. For those patients for whom such a test is overly optimistic, we might substitute that there is a reasonable probability of treatment compliance after release, or that the probability of treatment compliance has been enhanced. These criteria are to be thought of as rough and ready rules of thumb, and not as analytically precise tests.     

An Empirical Analysis of the Efficacy of the Wisc in the Diagnosis of Organicity in Children of Normal Intelligence

The Jungian concepts of archetypes and psychic reality are utilized to explain the difference between illusory and real psychic phenomena. Myths are defined as unconscious projections of archetypal material upon the environment, which assume definitive shapes as objects or persons having an archaic character. Only by an analysis of the meaning and value of the various mythological heros, motifs, or ancient objects depicted in a myth can an approach be made in comprehending the original archetypes from which they emerged. The difficulty of applying external scientific criteria of validity and reliability to a psychic event is explored at some length. In accordance with Jungian theory, “mental illness” is described as a myth which tends to isolate the observer from the one observed in a significant manner. Another way of looking at the “mentally ill” person is offered in terms of a common bond of humanity that exists between that person and one that is labeled as “mentally healthy.”     

Firearms and the mentally ill: A legislative overview and jurisprudential analysis

This article examines federal and state laws that prohibit the mentally ill from possessing firearms and assesses the jurisprudence that has developed as courts have applied the federal law. It argues that although there is little or no empirical data linking the mentally ill with firearms violence, legislative activity and popular political debate invariably include such restrictions on the mentally ill. Notwithstanding the proliferation of firearms and antecedent violence, this article suggests that legislators and policy-makers must separate this issue from the broader and more emotional issue of “gun control” in order to effectuate better public policy and simultaneously protect the constitutional rights of the mentally ill.     

Use of behavioral techniques by paraprofessional staff: A review and proposal

Paraprofessionals are increasingly being employed to provide direct care to children and adults who have behavioral deficits and excesses, such as those labeled developmentally disabled, mentally ill, or delinquent. Behavioral techniques, if effectively taught to paraprofessionals, offer ways of both teaching new skills to clients and reducing their undesirable behaviors. This article describes the methods that have been used to teach paraprofessionals to use behavioral techniques, how these skills can be maintained on the job, and the effects upon client behavior that result from this teaching of paraprofessionals. In addition, a system for teaching staff to implement and continue to use behavioral techniques is proposed.     

Tonkens on the Irrationality of the Suicidally Mentally Ill

abstract   Ryan Tonkens proposes that my Kantian approach to suicide intervention with respect to the mentally ill (2002) wrongly assumes that the suicidally mentally ill are rational and are therefore rational agents to whom Kantian moral constraints ought to apply. Here I indicate how the empirical evidence concerning the suicidally mentally ill does not support Tonkens' criticism that the suicidally mentally ill are irrational. In particular, that evidence does not support the conclusion that such individuals are systemically practically irrational so as to undermine the attribution of at least minimal rational autonomy to them. A Kantian moral framework, albeit one developed in a non-ideal direction, remains applicable to such individuals.     

Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness

In this study, we sampled sworn police officers from three law enforcement agencies (n=452), each of which had different system responses to mentally ill people in crisis. One department relies on field assistance from a mobile mental health crisis team, a second has a team of officers specially trained in crisis intervention and management of mentally ill people in crisis, and a third has a team of in-house social workers to assist in responding to calls. Calls involving mentally ill people in crisis appear to be frequent and are perceived by most of the officers to pose a significant problem for the department; however, most officers reported feeling well prepared to handle these calls. Generally, officers from the jurisdiction with a specialized team of officers rated their program as being highly effective in meeting the needs of mentally ill people in crisis, keeping mentally ill people out of jail, minimizing the amount of time officers spend on these calls, and maintaining community safety. Officers from departments relying on a mobile crisis unit (MCU) and on police-based social workers both rated their programs as being moderately effective on each of these dimensions except for minimizing officer time on these calls where the MCU had significantly lower ratings. © 1998 John Wiley & Sons, Ltd.     

Seven Vulnerabilities in the Pediatric Research Subject

Most recent thinking about thevulnerability of research subjects uses a``subpopulation' focus. So conceived, theproblem is to work out special standards forprisoners, pregnant women, the mentally ill,children, and similar groups. In contrast, an``analytical' approach would identifycharacteristics that are criteria forvulnerability. Using these criteria, one couldsupport a judgment that certain individuals arevulnerable and identify needed accommodationsif they are to serve as research subjects.Seven such characteristics can be evident inchildren: they commonly lack the capacity tomake mature decisions; they are subject to theauthority of others; they (and their parents)may be deferential in ways that can maskunderlying dissent; their rights and interestsmay be socially undervalued; they may haveacute medical conditions requiring immediatedecisions not consistent with informed consent;they may have serious medical conditions thatcannot be effectively treated; and they (andtheir parents) may lack important sociallydistributed goods. Each of thesevulnerabilities can call for special care inthe design and implementation of researchprotocols.     

Character and behavior in the mentally ill and well mother

The purpose of this study was to examine character and behavior in a group of mentally ill and well mothers. Mentally ill mothers differed from well mothers in mother-child interaction in their positive involvement in the feeding context and in overall optimal mothering during feeding. On measures of intrapsychic conflict and concern, mentally ill mothers demonstrated significantly more conflict in areas of trust, anger, self-esteem, mutuality and nurturance and more concern with issues of self-esteem, and giving and caring than well mothers. For the mentally ill mothers postpartum onset of illness and number of separations from her child were related to some aspects of character and behavior.     

Research Protections for Diverted Mentally Ill Individuals: Should they be Considered Prisoners?

The number of diversion programs for the mentally ill has increased dramatically over the past decade. These programs serve the valuable goal of reducing the growing population of incarcerated mentally ill persons by providing supervised community treatment. Research within these programs, critical for improving outcomes for these vulnerable individuals, is complicated by the fact that participants may have legal statuses which carry significant coercive leverage. In this way their ability to freely consent to research may be limited. In this paper, the authors describe the practice of diversion and review relevant research on coercion, informed consent and decisional capacity among the mentally ill and imprisoned. Current legal protections for prisoners are then discussed in the light of a recent proposal to broaden the legal definition of “prisoner” for research purposes to include community corrections populations, thus including diverted individuals. Copyright © 2011 John Wiley & Sons, Ltd.     

Accounting for the fear of schizophrenia

Research over the last three decades has demonstrated that a substantial minority of both professional and lay people have negative and rejecting attitudes towards the mentally ill. We argue that these attitudes may, in part, be a function of a tendency to perceive the mentally ill as somehow inherently dangerous and liable to violence. The evidence for the association between schizophrenia and violence suggests that although people with schizophrenia may be somewhat more likely to act violently than members of the general public, the magnitude of the differential is not sufficient to explain the perceived association. Alternative explanations for the correlation are therefore considered. Specifically, the influences of the media, errors in information processing and the process of stereotyping in accounting for the development of a perceived association between schizophrenia and violence are examined. Finally, the implications for enhancing the acceptance of people with schizophrenia into the community are discussed.     

Right of active duty military personnel to refuse psychiatric treatment

Under Federal Court precedents, mentally ill patients have a qualified right to refuse treatment. The amount of due process that may be required to override treatment refusals by active duty military patients is discussed. Due process for these individuals need not be judicial, since medical review satisfies federal requirements. Involuntary administration of medication to active duty military personnel is justified in some circumstances. Specific criteria for overriding treatment refusals are suggested. A sample protocol for overriding the treatment refusals of active duty personnel is offered.     

Co-occurring disorders among mentally ill jail detainees. Implications for public policy.

Studies have demonstrated that police often arrest the mentally ill when treatment alternatives would be preferable but are unavailable. Thus, jails may contain disproportionate numbers of severely mentally ill persons who have co-occurring disorders. Data on the co-occurrence of severe mental disorder, substance abuse, and antisocial personality disorders were gathered from 728 randomly selected male urban jail detainees. Using difference of proportions tests and loglinear analysis, the authors demonstrated that most subjects with a severe mental disorder (schizophrenia or a major affective disorder) also meet criteria for a substance abuse or antisocial personality disorder. These findings suggest several changes in public policy regarding health care delivery in correctional settings and for the general population.     

Mad Scientist: The Unique Case of a Published Delusion

In 1951, entomologist Jay Traver published in the Proceedings of the Entomological Society of Washington her personal experiences with a mite infestation of her scalp that resisted all treatment and was undetectable to anyone other than herself. Traver is recognized as having suffered from Delusory Parasitosis: her paper shows her to be a textbook case of the condition. The Traver paper is unique in the scientific literature in that its conclusions may be based on data that was unconsciously fabricated by the author’s mind. The paper may merit retraction on the grounds of error or even scientific misconduct “by reason of insanity,” but such a retraction raises the issue of discrimination against the mentally ill. This article asks what responsibilities journals have when faced with delusions disguised as science, what right editors have to question the sanity of an author, and what should be done about the Traver paper itself. By placing higher emphasis on article content than author identity, scientific integrity is maintained and a balance is struck between avoiding discrimination against the mentally ill and not preventing patients from seeking needed treatment.     

Compassion without illusion

This paper describes the present crisis in the mental health system relative to the chronically mentally ill. It asks how we can apply our usual social contract with the sick to noncompliant mental patients. The paper identifies some American assumptions about freedom and individualism that undermine a more effective response and offers alternative assumptions based on the Judeo-Christian tradition that may help resolve some difficulties.