Asylum not the answer for the chronically mentally ill.
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Biomedical subjects
Publications and source records attributed to A Gralnick.
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The author cites increasing numbers of chronic, homeless, and neglected mentally ill people as evidence of the failure of deinstitutionalization and community care to live up to their promise to reduce chronicity, the need for long-term hospitalization, and even mental illness itself. He believes the state hospital system, despite having been maligned and nearly destroyed, has great therapeutic potential. It could provide extended care to acutely ill patients before they become chronically ill; restore the ability to pinpoint responsibility for patient care, which has been lost under community care; and provide a stimulating academic environment conducive to research into treatment of the mentally ill.
Young adult chronic patients have become an increasingly difficult population for the psychiatric hospital to treat. These patients are also now of mounting concern to public officials and those who must deal with them in the community. The reports on treatment for these patients emanating from the public sector are far from encouraging. This study compares the results of treatment rendered in a private hospital with an active treatment program, with those from the public hospitals. The facts would suggest reason for hope in treating these young adult chronic patients.
The deinstitutionalization movement has given rise to an increasing number of young adult chronic patients in the community, a situation that poses a serious problem for both psychiatry and society. It invites a reassessment of both the policy of keeping patients in the community and the manner in which it has been managed up to this point. In recent years, a number of articles dealing with the young adult chronic patient have appeared. This article will review and offer a critique of some of that literature in an effort to place "the young adult chronic" patient in better perspective in relation to the deinstitutionalization phenomenon.
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Management of the character disorders in a hospital is synonymous with the therapeutic process itself. No single mode of therapy is the answer. The key seems to be a structured social setting, a therapeutic milieu involving an interdisciplinary team approach in which harmony, mutual trust and relative agreement about patient goals prevail.
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