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Biomedical subjects

H R Lamb

Publications and source records attributed to H R Lamb.

At least 73 records · Page 4Linked to original sources
PubMed1983

Mentally ill women in a county jail.

We studied 101 inmates of a county jail for women who were randomly selected from those referred for psychiatric evaluation. Eighty-six percent had a history of psychiatric hospitalization; 94% had prior arrest records, 50% of these for felonies. More than half met the criteria for involuntary hospitalization. When arrested more than 40% were transients, and only 7% were employed. Seventy percent had histories of serious physical violence, more than 40% had engaged in prostitution, and 84% of those with children had demonstrated an inability to take care of them. Far fewer mentally ill women than men were incarcerated in county jail. As in our study of male inmates, there appeared to have been some "criminalization" of the mentally ill. There is a need for more mandatory aftercare and ongoing involuntary treatment for this population.

Adult↗
PubMed1983

The new community consultation.

A large proportion of chronically mentally ill persons live in non-medical community residential facilities run by administrators and staff who are not specifically trained in the management of psychiatric patients; this situation makes consultation to residential facilities an issue of high priority. Consultants should be familiar with the facility's operating procedures; the wide range of social and vocational potential among long-term patients; and the needs of some patients for highly structured programs. They should be aware of the facility administrator's attitude toward mental health professionals and be prepared to deal with problems that can arise when they attempt to provide both consultation and direct service to the same facility. The authors recommend that consultants advise administrators on issues such as determining admission criteria; understanding the mental health system; and handling a variety of difficult behaviors.

Antisocial Personality Disorder↗
PubMed1982

The mentally ill in an urban county jail.

One hundred two male inmates of county jail, randomly selected from those referred for psychiatric evaluation, were studied. Ninety percent had had psychiatric hospitalization; 92% had prior arrest records, 75% for felonies. Four fifths exhibited severe, overt psychopathology. More than three fourths met the criteria for involuntary hospitalization. When arrested, more than one third were transients and only 12% were employed. Thus, this population is characterized by extensive experience with both the criminal justice and mental health systems, severe acute and chronic mental illness, and poor functioning. More than half were currently charged with felonies and 39% with crimes of violence. We were also attempted to determine why inmates had been arrested rather than hospitalized and whether there has been "criminalization" of the mentally ill. There appears to be a need for more emphasis on ongoing involuntary treatment for this population.

Adolescent↗
PubMed1982

Young adult chronic patients: the new drifters.

Young chronic patients are faced with the same concerns and life-cycle stresses as others in their age group. They strive for independence, satisfying relationships, a sense of identity, and a realistic vocational choice. Lacking the ability to withstand stress and intimacy, they struggle and often repeatedly fail. The result is anxiety, depression, psychotic episodes, and hospitalizations; gradually many begin to give up the struggle. Such concerns may become intensified during the reassessment of life that takes place at about age 30. Denial of illness, the rebelliousness of youth, and issues of control and violence compound the problems. Since deinstitutionalization, patients can no longer take asylum from stresses in a lifetime of hospitalization. Many patients drift from one city to another, or from one living situation to another. Some ways of approaching these problems, such as working with younger patients while they may still be motivated to make changes, helping them develop appropriate rationalizations, and supporting realistic goals, are discussed.

Achievement↗
PubMed1981

Legislating social control of the mentally ill in California.

The Lanterman-Petris-Short Act in California has been acclaimed for protecting the civil rights of the mentally ill and curbing unnecessary involuntary psychiatric hospitalization. Its passage, however, has not prevented an increase in the rate of involuntary admissions to state hospitals and a marked decrease in the rate of voluntary admissions. This has greatly changed the functions and problems of state hospitals. In local as well as state hospitals large numbers of people continue to become involuntary psychiatric patients. In many cases this results from gaps between the law and its implementation. It appears that professionals, the courts, families, and society generally feel a continuing need for social control of the mentally ill.

California↗
PubMed1981

Encouraging psychiatrists to work with chronic patients: opportunities and limitations of residency education.

In recent years, psychiatrists in both the public and private sectors have been insufficiently involved in the treatment of chronic psychiatric illness. Simultaneously, deinstitutionalization has made the treatment of chronic patients more complex. In this paper the authors discuss the use of medical education- specifically the psychiatric residency-to increase the number of psychiatrists involved in the treatment of chronic patients and to improve the quality of treatment. Optimally residency programs should provide intense, long-term contact with chronic patients, supervised by role models committed to the treatment of such patients. Programs should encourage appropriate attitudes, including realistic treatment expectations and understanding of the issues of patient passivity and dependence; convey specialized knowledge related to housing, ethnicity, occupational, social, and legal matters and train residents in treatment skills tailored to patient needs, including the ability to perform functional diagnostic assessments and to collaborate with other mental health professionals.

Chronic Disease↗
PubMed1981

What did we really expect from deinstitutionalization?

Long-term, severely disabled psychiatric patients are almost by definition a marginal population. Yet the expectations of deinstitutionalization are often expressed in such terms as "helping them become a part of the mainstream of our society" and "normalization." Although only a minority of long-term patients can realize these expectations, the programs that receive the most attention are those geared to the higher-functioning minority. When scrutinized, proposed "solutions" to the problem of deinstitutionalization are found to be simplistic and unrealistic. Deinstitutionalization will have accomplished a tremendous amount if the mentally ill can live lives of dignity and a reasonable amount of comfort in the community, a good that will require increased investment of both effort and funds in their living arrangements. The private sector, given sufficient financial incentives and proper supervision and support, can provide quality services to chronic patients on a large scale.

Activities of Daily Living↗
PubMed1981

Obstacles to psychiatric rehabilitation.

There is reluctance to fund rehabilitation appropriate to the needs of the severely disabled. Further, the deterrent effects resulting from the way income maintenance programs have been set up and administered reinforce the secondary gain of mental illness. It would seem that society has decided to "pay off" the mentally ill rather than to rehabilitate them. Some suggestions are made to help remedy this situation.

Community Mental Health Services↗
PubMed1981

Securing patients' rights--responsibly.

The patients' rights activist has power without clinical responsibility. Major problems can result when power is wielded by people who lack an appreciation of the clinical complexities of work with the severely mentally ill. The patients' rights movement has been an extremely constructive force, but every movement, no matter how well intended, must be monitored so that more good than harm is done. Two advocacy cases in which the struggle itself seemed to be more important to the advocates than the rights or welfare of the patients are described. Mental health professionals should not treat patients' rights as if they were a sacred cow, but should distinguish responsible advocacy from irresponsible advocacy. Long-term, severely ill patients, in particular, need to be protected from irresponsible "benefactors." The author's suggestions include that advocates be required to have experience providing direct service to severely disturbed patients for six months to a year and that advocates be rigorously screened within bureaucracies.

Attitude to Health↗
PubMed1980

Board-and-care home wanderers.

At six-month follow-up, 32 of 101 psychiatric patients in a board-and-care home had moved on. In this sense a considerable proportion of this population is not a static group. A relationship was found between moving on and having resided in the board-and-care home 12 months or less, being younger than 30 years of age, having goals to change something in one's life, and hospitalization during the preceding year. Repeated attempts at independent living appeared to stem from a search for autonomy and a sense of mastery, and resistance to the pull of dependency. Moving on, for some, seemed to be an attempt at a geographical solution to internal problems. Ambivalence and the need of both residents and families for respite appeared to be reflected in moves back and forth from living with each other.

Follow-Up Studies↗
PubMed1980

Structure: the neglected ingredient of community treatment.

Eighty patients in a locked, skilled-nursing facility that serves only psychiatric patients were studied. Of these, 78 were diagnosed as psychotic, 48 had overt major psychopathologic characteristics, and 33 had been physically assaultive within the past 12 months. A third had diagnoses both of psychosis and severe drug and/or alcohol problems. Fifty-eight were unmanageable in previous placements in open settlings. Four of five were resistant to taking psychotropic medications. Six were judged dangerous to themselves. Such patients are extremely difficult to manage in community settings where the need for structure is often overlooked; therefore, this facility, serves as an alternative to the state hospital. Structure is provided not only by security features but also by an intensive treatment and rehabilitation program. This type of facility is contrasted with the state hospital.

Adolescent↗
PubMed1980

Therapist-case managers: more than brokers of services.

For satisfactory adjustment into the community, the long-term patient often needs assistance in dealing with a bureaucracy of agencies and departments. Some professionals have suggested establishing the role of case manager, but the case manager system is susceptible to becoming an impersonal bureaucracy itself. The author suggests that case management functions are part of the normal duties of a conscientious therapist, and that only through significant therapeutic involvement does a case manager acquire the in-depth knowledge of the patient to adequately assess his needs and facilitate the processes for meeting them. Thus the case manager should be not simply an intermediate broker of services but the patient's primary therapist. With the "therapist-case manager," the functions of therapy and case management would be combined. If therapists fail to do case management or to treat long-term patients altogether, this problem should be dealt with directly rather than simply by adding another member to the team.

Community Mental Health Services↗
PubMed1979

The new asylums in the community.

One-hundred and one residents of a board-and-care home housing psychiatric patients were studied. Of these, 92% were diagnosed as psychotic; 42% have lived there five years or more; and 32% have overt major psychopathologic characteristics. Nine of ten have never lived alone or failed in their last attempt. A relationship was found between use of a community social rehabilitation program and its distance and provision of transportation. Sixty-one percent have had contact with community vocational rehabilitation but only 12% are still involved. Half of them have no goals for changing anything in their lives; 95% use community facilities, mostly eating places and supermarkets. Board-and-care homes offer an asylum from life's pressures, a degree of structure, and some treatment, especially medication supervision. For many long-term patients they have taken over the functions of the state hospital.

Adult↗
PubMed1979

Day treatment and psychotropic drugs in the aftercare of schizophrenic patients. A Veterans Administration cooperative study.

Schizophrenic patients referred for day treatment at the time of discharge from ten hospitals were randomly assigned to receive day treatment plus drugs or to receive drugs alone. They were tested before assignment and at 6, 12, 18, and 24 months on social functioning, symptoms, and attitudes. Community tenure and costs were also measured. The ten day centers were described on process variables every six months for the four years of the study. Some centers were found to be effective in treating chronic schizophrenic patients and others were not. All centers improved the patients' social functioning. Six of the centers were found to significantly delay relapse, reduce sumptoms, and change some attitudes. Costs for patients in these centers were not significantly different from the group receiving only drugs. More professional staff hours, group therapy, and a high patient turnover treatment philosophy were associated with poor-result centers. More occupational therapy and a sustained nonthreatening environment were more characteristic of successful outcome centers.

Adult↗
PubMed1979

Roots of neglect of the long-term mentally ill.

A pattern of neglect of the severely mentally ill, then outrage and movements for reform, followed again by a lapse into neglect has been characteristic of the mental health professions and society generally. This article explores the possibility that neglect of the mentally ill may be rooted in professionals' dissatisfaction with meeting chronic dependency needs, a moral disapproval of dependency and passivity, a distaste for the lower social classes, and an inclination, like that in the larger society, to exclude the mentally ill. The discussion then turns to the problem of the overselling of rehabilitation and the observation that despite the powerful dependency needs and limited tolerance for stress of the mentally disabled, when attention is finally turned to them, neglect often gives way to unrealistic expectations of rehabilitation. The paper concludes with recommendations for alleviating these problems.

Attitude of Health Personnel↗
PubMed1979

Primary prevention in perspective.

Discussion of primary prevention has been made difficult by lack of clarity of underlying concepts and assumptions. Is the purpose to prevent diagnosable mental illness or to prevent unhappiness and social incompetence? What are the implications of the assumption that societal stress causes mental illness? Is there a clear distinction made between major and minor mental illness? Except for a few specific conditions there is little evidence that primary prevention has been effective. The authors feel that research and program evaluation in prevention is sorely needed but should be funded separately and with discretion. Scarce mental health funds should not be diverted from direct treatment for this purpose.

Adult↗