Biomedical subjects
Publications and source records attributed to L R Faulkner.
The unplanned extension of the right to refuse treatment to the precommitment period is described in this paper. This extension of the right to refuse treatment has important public policy implications for the civil commitment process. These implications, as well as the pros and cons of the extension of the right to refuse treatment, are discussed.
The prevalence and significance of medical illnesses were examined in a sample of chronically mentally ill patients from an urban community mental health program. Eighty-eight percent had at least one significant medical illness, 51% had at least one previously undiagnosed illness and 53% were judged to be in need of some form of medical attention. The bulk of these illnesses were typical of primary care problems. In terms of causal significance, nearly as many medical illnesses appeared to be the result of the psychiatric disorder (18%) as vice versa (22%). Community mental health programs should make provisions for the medical needs of patients in comprehensive management programs.
The authors review the relationship that has evolved over the years between the Department of Psychiatry at Oregon Health Sciences University and Oregon's community and state mental health programs. They describe the compatibility that exists between the basic requirements of academic psychiatry departments and public mental health programs and demonstrate how these organizations have been able to fulfill one another's needs in Oregon. Specific examples of successful collaborations in the areas of education, administration, research, and service are presented to illustrate how relationships that have been designed to meet specific requirements of one organization can fulfill many requirements of both. Suggestions are provided for those organizations contemplating similar collaborative endeavors.
The authors present a brief overview of competency determinations in criminal justice and civil commitment proceedings and review the American Psychiatric Association's Model Commitment Statute, which gives competency a central role. They present an alternative proposal that involves determining a person's competency to undergo civil commitment before a formal commitment hearing and delineates the responsibilities of legal and medical decision makers in the commitment process.
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Executive directors of Oregon's 36 community mental health programs were surveyed in the fall of 1983 to determine the nature of psychiatric services offered and the roles played by psychiatrists. The study showed that a total of 18.2 full-time-equivalent psychiatrists were working in the community system, a mean of .5 per program, considerably below the national average. None of the responding directors were psychiatrists, and only six employed psychiatrists as medical directors. The directors valued psychiatrists most highly for their skills in educating, supervising, and consulting with staff; for their unique clinical skills; and for medication management. They considered the biggest disadvantage of employing psychiatrists to be the expense. The authors discuss factors that contribute to psychiatrists' satisfaction with work in community mental health programs and strategies for recruiting and retaining psychiatrists in the programs.
Although the United States Supreme Court has not offered a definite opinion, some states have established the qualified right of involuntarily committed patients to refuse treatment. Controversy continues between psychiatry and law over what procedural protections should be provided to patients when therapists seek to override nonemergency refusal of treatment. The authors review Oregon's administrative approach and its application to the treatment refusal of 33 state hospital forensic patients. Patient characteristics, refusal patterns, and implications of treatment refusal are also described.
The authors expand their methodology for quantifying and comparing civil commitment processes by developing new formulas for the determination of the average commitment detention time and cost. They also examine the effects of specific changes in commitment procedures on the average detention time and cost. Using data from Oregon's civil commitment process, the authors present several examples of the practical application of their methodology and conclude with a discussion of its major administrative and research implications.
The authors present a three-step civil commitment model and formulas for calculating 1) the probability of release from the commitment process and 2) the relative importance of the three steps in determining outcome. Using data from Oregon's civil commitment process, they present five examples that demonstrate how their method might be used to study and monitor civil commitment processes within and between jurisdictions. The major public policy and research implications are discussed.
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In 1980 the authors reviewed the records of the first 130 patients to enter small group work therapy, a program begun in 1964 by Arkansas State Hospital and Arkansas Rehabilitation Services in which chronic schizophrenic patients live in group homes and work in Hot Springs. Forty-five of the original patients were still in the program in 1980. Although the patients had been hospitalized for an average of 11 years, they spent an average of seven years in the program, during which time their hospital utilization dropped significantly. Forty-two were discharged to settings offering greater independence. The authors focus on the role of a rehabilitative unit of Arkansas State Hospital known as the HIP unit, which, until it was closed in 1976, prepared patients to live and work with each other before entering small group work therapy.
We review a three-step civil commitment model and formulas for calculating the probability of release from commitment and the relative importance of the three steps in determining the outcome. New formulas are developed which enable predictions to be made about the effects of changes on the outcome of the three steps on the release probability. With the use of data from Oregon's civil commitment process, we present an example of the application of the methodology and conclude with a discussion of its major administrative and research implications.
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This paper examines the common characteristics of chronic psychiatric patients and the principles that should guide the development of any program of activities designed to promote their rehabilitation. A range of productive activities in each segment of a support network is described, and an example from Oregon is presented to illustrate how different levels of activities can be used to meet rehabilitation goals.
The authors report data from a survey of chairmen of academic departments of psychiatry and chiefs of Veterans Administration (VA) psychiatry services concerning administrative relationships between academic psychiatry departments and VA psychiatry services and the education of psychiatry residents in VA settings. The extent and quality of relationships, the interdependence of academic departments and VA psychiatry services, factors important for good VA training, and advantages and disadvantages of using the VA for residency education are documented. The authors present their conclusions and recommendations for improving the quality of relationships between academic departments and VA psychiatry services and for strengthening psychiatric education in the VA setting.
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To review administrative relationships between academic departments of psychiatry and state hospitals the authors sent a questionnaire survey to chairmen of the 115 psychiatry departments in the United States with approved residency programs, receiving responses from 98 (85%). They discuss three types of relationships and examine the nature of the training of university residents in state hospitals, providing suggestions for integrating service-oriented settings such as state hospitals into an academic psychiatry program.
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