Biomedical subjects
Publications and source records attributed to H Ryglewicz.
Our first generation of young adult chronic psychiatric patients since deinstitutionalization has emerged in the community. Updated research results and case studies show different patterns of emergence but similar indications for clinician response.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Unified services is a further development of the concept of a community mental health center, with the aim of providing coordinated, flexible, continuous, and nonduplicated services. Various states have attempted to translate the concept into systemic changes through legislation, usually making the approach optional. New York State, where five counties have adopted unified services, is used as the primary example; planning and coordinating for all services are in the hands of the counties. The authors discuss over-all benefits of unified systems, and territorial and fiscal problems in implementing them. States are at different stages of developing unified systems, ranging from maintenance of two separate systems of institutional and community programs to integration of planning and services but not funding. What is needed is a mechanism to integrate funding as well, a mechanism through which funds going to agencies will reflect the actual proportions of patients served.
A new generation of persistently dysfunctional young adults (aged 18 to 35) has emerged in the community, requiring new programs in community care. This population, which includes a wide range of diagnostic groups, is under study at a suburban New York community mental health center. The center and county are serving 294 such young patients through a variety of programs which include a crisis service, a sheltered workshop, a residential program called the Community Link-Up Experience, an acute day treatment program, an alcohol day treatment program, a case management program, and a Growth Advancement Program that gives patients an opportunity to socialize and share problems with others their age. Residential programs that provide a supportive living situation to young adult chronic patients on both a temporary and a long-term basis are sorely needed and will require an increased outlay of funds. A case study of one young patient who visited the center sporadically over a 12-year period illustrates the treatment problems such patients pose.
We are fast approaching a centennial of New York State's institutional system, the anniversary of the State Care Act of 1980. This can be evaluated against another important anniversary; the quarter century mark of the current convulsion/revolution of the mental hygiene care system of the entire United States, commonly referred to as deinstitutionalization. The state institutions, which for the past century were built up and maintained as the major locus of care for the chronically mentally ill, no longer occupy that central place in many localities. Yet these hospitals must continue to struggle with overwhelming burdens. Their inpatient populations, although now much smaller, still include many seriously mentally ill patients as well as the essentially non-dischargeable elderly. In addition, they must provide for young adults with a new profile of difficult behavior and challenging demands. This article is an attempt to redefine the role of the state institution in what has become the new era of community care, and to suggest fruitful new directions for the future which incorporate a contemporary shift in focus: from the concept of illness to that of disability, and from a reliance on a facility or specific program to the development of a comprehensive and integrated system of treatment and support services.