Assessing the acute inpatient psychiatric needs of the state hospital patient.

Regulators have a major opportunity to enhance the community care of former state hospital patients through their power to authorize additional general hospital psychiatric beds. The authors propose a series of clinical criteria for such regulators based on a review of state hospital admissions. These include provisions for patients who have chronic illness with repeated hospitalizations, who are involuntarily admitted, who have alcoholism, and who are impoverished. Further implications for general hospital units include specific changes in their treatment strategy, their links to facilities for ambulatory patients, and their provisions for staff education and support.

The psychiatrist and the statewide health coordinating council: strange bedfellows.

Psychiatrists and statewide health coordinating councils are products of widely disparate cultures, yet they share the goal of providing the highest quality patient care, and to achieve it they must work together. The author describes the functions of statewide coordinating councils, the cultural influences that make it difficult for psychiatrists and coordinating councils to work together effectively, and his own experiences as a member of the coordinating council in Massachusetts. He emphasizes the need for psychiatrists to become more actively involved in planning efforts if they are to have an impact on the delivery of mental health services, serve the needs of their patients, and retain control of the future of their profession.

A learning opportunity for community psychiatry.

Training in community psychiatry is becoming an integral part of psychiatric residencies. This paper outlines the contribution to such training of Job Corps centers, serving as teaching laboratories in community psychiatry. As the only national training program for disadvantaged adolescents, Job Corps operates 123 centers across the country. Each center functions as a community in microcosm and provides an excellent opportunity for the learning and study of mental health consultation and social system dynamics. The Job Corps Mental Health Program provides a learning opportunity for psychiatrists at all levels of development.

Deinstitutionalization in the absence of consensus.

The process of deinstitutionalization began almost unnoticed in 1955 as state hospital populations started to decline, and it proceeded without adequate planning and without development of a social consensus. The inevitable result was strong criticism, severe personal dislocations, and, with rare exceptions, programmatic chaos. The authors trace and describe the reasons for the growing polarization about deinstitutionalization among such groups as mental health professionals, public officials, families, advocacy groups, citizens, and unions. They also note that between 1950 and 1970 the total institutionalized population in the U.S. was not reduced but simply shifted. Deinstitutionalization should focus not on the location of care but on the broader problem of improving the lot of persons with chronic illness, regardless of its cause or time of onset, the authors suggest. They outline the basic elements of a service and financing system to meet both the daily-living and the specifically medical needs of the chronically ill.

Mental health in the job corps: An exploration of the role of the mental health worker in programs of education and training.

Recent years have seen the proliferation of programs of education and training. Mental health workers have become increasingly involved in such programs and have provided varied services. This paper reports the experience of psychiatrists, psychologists, and social workers in the Job Corps, the most intensive and only nationwide residential training program for disadvantaged youth. It is a report on the proceedings of the First Job Corps Mental Health Colloquium held in June, 1967. Moreover, the paper is an exploration of the role of the mental health worker in this and other similar programs.