Can the public psychiatric administrator be ethical?
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Biomedical subjects
Publications and source records attributed to R Peele.
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The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.
The proliferation of standards and quality assurance programs is posing a major problem for mental health administrators. The authors review some of these problems and emphasize the differences between cost and quality controls. They propose that quality controls be judged on their ability to improve patient care and suggest that administrators consider the establishment of quality control offices.
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As a pilot project within a psychiatric residency program, two psychiatric residents conducted a six-month interviewing and data-recording course for paraprofessionals in a comprehensive community mental health center. The program benefited the paraprofessionals and the institution, but the authors feel the most important benefits were to the residents themselves. Through the project they grappled with and tested solutions to such issues as accountability, delegation of clinical responsibility, supervision of subordinates, administration, and leadership.
In delivering mental health services, community psychiatry operates under two contracts: one between the community and the provider of services and one between the provider of services and the individual or organization requesting them. Each party in the contract has a system of ethics and values that determines its conception of what services should be available and how they should be delivered. Often there are conflicts. Using case studies from a community mental health center, the authors discuss many of the conflicts and ways of resolving them.
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