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An earlier paper presented findings which indicated that mentally ill persons described as exhibiting identical behavior were increasingly rejected when they were described as utilizing no help, utilizing a clergyman, a physician, a psychiatrist, or a mental hospital. Controls for age, religion, education, and social class position failed to diminish the relationship between help-source and rejection, but controls for experience with an emotionally disturbed help-seeker and for adherence to the norm of self-reliance tended to specify it. The previous paper was concerned with the stability of the relationship between help-source and rejection within each of the control groups, and not, for the most part, with differences among groups. In this paper, the main focus is on a comparison of the effects of educational attainment on the relation between help-source and rejection. A further focus is on the influence of (a) experience with mentally ill help-seekers, and (b) attitude toward the norm of self-reliance, two variables that serve to interpret the relationship between education and rejection. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

Why do marriages which are basically neurotic survive? Why do married couples who live together in a basically neurotic relationship for a number of years suddenly seek psychiatric assistance? This paper raises these questions and finds that such marriages begin with mutually complementary-need systems which quickly become interlaced. Since both partners obtain gratification for their neurotic needs, the marriage tends to endure. Psychiatric assistance is sought when some specific event occurs which clearly disrupts the neurotic equilibrium and alters the neurotic gratification each partner receives from the relationship. [ABSTRACT FROM AUTHOR]

This paper examines aspects of school nursing and its work setting as bases for the interactive nature of nursing practice in schools. Mental health consultation is presented as a means of reducing role stress and increasing effectiveness. A case example of the consultative process is given. [ABSTRACT FROM AUTHOR]

The article presents a discussion of the orientation of mental health professionals toward human services in the U.S. The author in this paper has traced the development of ideology among mental health professionals and has concluded that a more inclusive human service belief system is developing among mental health and other community caregivers. Growing out of the community mental health ideology which gained prominence during the nineteen sixties, the human service orientation is seen as potentially playing a major role in rationalizing and justifying an even more expanded pattern for organizing comprehensive integrated programs of service for the nineteen-seventies.

Hospitalized mental patients are increasingly being discharged into the community. Yet, despite the construction of hundreds of community mental health centers, readmission rates continue to rise. This paper analyzes the reasons for this problem and provides suggestions for its solutions. [ABSTRACT FROM AUTHOR]

The article presents abstracts of various research papers published in the June 1961 issue of "Journal of Health and Human Behavior." One of the abstract discusses the relationship between and intrapsychic processes. Another abstract presents a study which attempts to ascertain, and account for, the presence of significant differences in knowledge of attitudes toward mental disease between a sample of high school boys and one from a boys' reformatory. The purpose of one of the papers on hospital-patient relationships is to clarify the precise nature of the relationship between mental hospitals and patients and to compare and contrast it with the relationship between medical hospitals and patients. Another paper on mental hospitals presents information about four types of "pathway" organizations which seek to assist in the transitional period between the discharge of a mental patient from a hospital and his re-entry into community life. The four general types considered are day hospitals, halfway houses, sheltered workshops, and ex-patient organizations.

This paper is a report of a study by Horizon Noun, Philadelphia, Pennsylvania, aimed at reactivating dropouts from a psychiatric rehabilitation program. The experiment's goals were twofold: (1) to reach the dropouts by using two forms of contact--the telephone conversation and the home visit---and (2) to determine whether a differentiation could be made between the dropouts and a control group of active clients. [ABSTRACT FROM AUTHOR]

This paper reports a study of thirty nonrelative adopted children referred to a psychiatric facility. Descriptive data are presented on the adoption, the child's symptomatology, and the frequency of requests for out-of-home placement. Potential difficulties in adoptive placements are suggested for further study. [ABSTRACT FROM AUTHOR]

Many practicing social workers need more accessible points of referral for clients with special problems, especially when those problems are emotional and mental. This article focuses on a research, which reports and analyzes a set of paradoxical findings from a survey of the opinions of a cross section of a community's social agencies with respect to the proportion of mentally and emotionally disturbed clients handled and the psychiatric facilities needed for their referral and consultation about them. This research paper also classifies agencies according to their function and clients according to the agencies' descriptions of the problems they present; reports the perceived needs in terms of the type of agency and its clientele; and discusses the agencies' perceptions and their significance for the introduction of new services. Workers in most supportive agencies would like psychiatric guidance for two reasons: to help in their own treatment and understanding of the client and for help in selecting clients for psychiatric therapy. Many workers took the opportunity of mentioning the need for better co-ordination of concrete services for their clients.

Among the Egba-Egbado Yoruba peoples of Nigeria there are several village psychiatric treatment programs. Nigerian psychiatrists believe that such village programs have greater therapeutic and economic efficacy than treatment modalities and structures commonly found in Western society. This paper discusses the identification and assessment of social and cultural elements which enhance or detract from the therapeutic potential of the village treatment programs. Psychological, social and cultural data are utilized to suggest comparisons between Yoruba therapeutic communities and Western psychiatric communities. The potential of these programs and further refinement of the concept "therapeutic community" are also considered. [ABSTRACT FROM AUTHOR]

Based on a review of problems in treatment evaluation in mental health centers, this paper offers a theoretical rationale and a methodology for dealing with them using automated computer techniques. [ABSTRACT FROM AUTHOR]

This research paper focuses on an attempt to validate a measure of mental health. The subject of the investigation is a scale included in a study of mental health in an urban area of southwest Michigan. The twenty-two questions used in the scale had been designed to assess the mental health of respondents in the New York Midtown study. Responses to these questions had correlated with the mental health ratings given by the Midtown study psychiatrists. One of the aims of the present study was to appraise the concurrent validity of a mental health scale derived from the questions used in the Midtown study. The scale was based upon a simple addition of the number of questions that were answered positively by the respondent. A summary score of "0" represented best mental health while higher scores were indicative of progressively poorer mental health. This scale will be referred to as the 22 Item Mental Health (MH) Scale. Two main techniques were used to evaluate validity. The first was the known groups procedure, in which the questions were administered to samples drawn from populations whose mental health was known or might be estimated. The second was the independent criteria method, in which other measures of mental health were compared with the results obtained from the 22 Item MH Scale.

This paper presents a feminist interpretation of mental illness based on national statistics, mental health surveys, psychological and sociological experiments, psychological analytic theories and practices, and on an original study. An analysis of NIMH statistics revealed that 125, 351 more women than men have been psychiatrically hospitalized from 1964-1968. From 1 950-1968, 223,268 more women than men were hospitalized in state mental asylums. Female patients generally outnumber males in private treatment, and both significantly prefer a male rather than a female therapist. These facts are discussed as one of the effects of sex-role stereotyping and the oppression of women. [ABSTRACT FROM AUTHOR]

The article discusses the issues concerning the training and deployment of social work manpower in the U.S. Manpower problems involved in providing health and medical care services to the total population of the country has, for the first, been recognized by health professionals, the consumers of services and policy-makers. Another concern in the country's health system is the significant changes in the organization and structure of the health and mental health services, which will have great impact on the ultimate delivery of service.

Nowadays a significant amount of writing related to the treatment of emotionally troubled persons is devoted to examining the broad base of human experience. On this count the existentialist writers and professional people have enlarged the understanding of the range and scope of human potentialities and capacities. Thus, many members of the helping profession have not been satisfied merely to refine their therapeutic techniques, or to accumulate psychodynamic information, they are now addressing themselves to an understanding of the human condition. During recent employment in a psychiatric outpatient clinic, the worker worked with a 31 year old single man on a weekly interview basis over an eight-month period. The patient had two previous experiences with therapy in clinic settings that, according to him, had not been helpful. Specific innovations in therapy seemed called for because of the nature, chronicity, and extent of the patient's problems, the type of defenses he employed, his capacities and strivings, and the failure of more traditional psychotherapeutic methods.

A different type of psychiatric emergency program is described and preliminary data concerning its operation are presented. The program provides emergency service ranging from outpatient visits to twenty-four hour care. Further reports are anticipated. [ABSTRACT FROM AUTHOR]

Mental-health care is a major public-sector problem in the State of New York. We were asked by the Ways and Means Committee of the New York State Assembly to recommend a new fiscal structure with shared funding; between the state and the counties to better achieve the objective of the state's mental-health-care program. We developed a simulation model for the problem and used it to design new funding plans; the results of our analysis have been written into legislation introduced into the New York State Assembly. [ABSTRACT FROM AUTHOR]

Viewing comprehensive health centers and community mental health programs as links in a delivery system that may provide the framework for a possible national health system, five goals in planning and providing liaison-care are described. A case illustrating this interaction is presented. [ABSTRACT FROM AUTHOR]

One hundred and ten clients of a psychiatric clinic were interviewed to discover why they had decided to undertake psychotherapy. To study this depth decision an accounting-scheme technique was used consisting of five stages, the first of which, recognition of an emotional problem, was the focus of the study. Four typical ways of discovering that one had a problem were found: being told by others, experiencing painful physical symptoms, being unhappily married, and simply feeling diffused unhappiness. These types were found to differ with regard to their definition of the problem, their use of mass media, and their response to treatment. Those who recognized their problem through introspection and could change their self-image from that of a normal to a disturbed person had the best chance of being accepted by the clinic and of continuing their treatment. [ABSTRACT FROM AUTHOR]

A one-year follow-up of two hundred psychiatric outpatients was conducted in order to determine the relative efficacy of various treatment modalities in a crisis service unit within the Emergency Room of the Sinai Hospital in Baltimore. It was discovered that improvement at follow-up was related to the amount of medication taken, as well as the duration and type of psychotherapy. Additionally, it is argued that improvement consisted not only in the absence of symptoms at follow-up, but also in "conversion" to more socially acceptable symptoms. Some implications and limitations of the data for the utility of crisis services in general are considered. [ABSTRACT FROM AUTHOR]

The development of a coordinated program utilizing a team approach to care of discharged psychiatric patients is described. [ABSTRACT FROM AUTHOR]

Eight conceptual models of community are presented with brief outlines of the implications of each model for several characteristics of community mental health centers: characteristics of the target population and mental health staff, staff awareness of community needs, the effect of programming on the community, and the roles of citizens and staff. [ABSTRACT FROM AUTHOR]

The development of an information system for a state health department is considered in terms of cybernetic and information theories. [ABSTRACT FROM AUTHOR]

A report is presented on emergency services in community mental health. Clarification of such services is discussed as is crisis intervention. Recommendations are made for the operation of crisis intervention programs. [ABSTRACT FROM AUTHOR]

Description and discussion are presented of a program for more than 76,000 employees to deal with mental health problems that have an effect on employment, work habits, and related matters. The broader significance of such activities is stressed. [ABSTRACT FROM AUTHOR]

A study was made to see what categories of cases were referred to mental health consultants by health agencies, and to see whether in the course of time there was any change in the distribution of cases among the categories. Findings are reported. Although the original intent was not completely fulfilled, the discussion of the problems encountered will be of value to other investigators. [ABSTRACT FROM AUTHOR]

The article examines relevant policy issues in context of citizen participation from a cross-cultural perspective, specifically in relation to community mental health centers, which are actively invoked with this process. The Community Mental Health Centers Act of 1963 addressed the problem of the availability of services to those persons who could not afford private psychiatric care and it developed a highly decentralized network of services tailored to suit local conditions and meet local needs. Citizen participation, which was viewed as desirable and was frequently part of the planning and design process, was mandated in 1972 to take place on a continuing basis. The Yugoslav programs described have special implications for community mental health centers in Yugoslavia, and findings can be generalized to other health and welfare services. The Yugoslav experience is examined in light of its philosophy and objectives, with little attention being given to problems and dilemmas within the political system; the material is descriptive rather than analytic. It is important to recognize that a different set of problems exists in the United States, where self-management and citizen participation are the exception rather than the rule.

Study of 103 families revealed that adequate parental knowledge of their child's condition, together with warm family relations and supportive social situations, are factors associated with adaptation of a family to the presence of a mentally handicapped child in the home. The critical nature of the parents' experiences and reactions during the Initial birth crisis suggests the help fulness of early casework counseling toward sound placement decisions. [ABSTRACT FROM AUTHOR]

This article describes a study of the expectations of middle- and lower-class patients on entering psychotherapy. The results showed that although both groups are aware of the subject matter to be covered, they differ in their expectations of treatment techniques. Similarities as well as differences exist, with various explanations offered to account for them. [ABSTRACT FROM AUTHOR]

This article presents information on various issues related to social work. The major aim of the study was to enhance knowledge relevant to the total care of fatally ill children, i.e., the extent of their emotional problems. This information is valuable for effective program planning. For example, if a child were aware of or suspected the significance of his illness that is, his impending death, the accompanying anxiety would be highly upsetting to him and would become a concern for staff. More important, perhaps, is how the child is handling his anxiety. The ability to tolerate anxiety is considered a positive mental health value. A guiding principle suggests that treatment of a child with a catastrophic illness should deal with the mental health of the child and his family. Some studies have focused on mothers of children hospitalized with leukemia. The threatened and actual loss of a child can be a traumatic experience for the child, the mother, and the family as a whole. The anxiety present in such a situation is a complex interaction between family members, particularly mother and child.

This article presents information on the importance of effective placement of the adult psychotic into a new family which is, obviously, a clinically difficult step. In essence, the patient is confronted with the anxiety provoking problem of negotiating parental and sibling substitutes in the form of foster parents and other members of the foster family. The patient and his history reveal the significant areas of disorder and distortion in family relationships: his way of relating, his fantasies, his image of parental figures, his efforts at reality testing, and his capacities to handle stress. The issue of placement often resurrects old distorted patterns in turn producing fearful, regressive behavior which, along with other factors involved in placement, must be understood and dealt with by the caseworker to help the patient toward better functioning. The 1500 bed VA neuropsychiatric hospital at Bedford has had over a decade of experience in the VA foster home program. As a teaching hospital, its aim has been to organize and cultivate an intensive foster home treatment program of moderate size. Since 1949, when the program began, the hospital has had ample opportunity to observe in a great many cases the significance of early family experiences in the patient's reaction to placement as revealed through direct communication and reactive behavior.

This article is based on a review of the literature of casework and psychotherapy, with a view toward differentiating between the practice of the two professional methods and formulating for each a definition that may be helpful in establishing a set of defining criteria. The findings reported are based on publications dating from 1935 to 1955, authored by psychiatrists and social workers who addressed themselves to differentiating social casework from psychotherapy as a treatment method. The majority of psychiatrists regard psychotherapy as being identified with the medical profession. Psychiatrists who have worked closely with other professions in the field of mental health express a more liberal view. An important, constructive change in the emotional life of a patient is the goal of psychotherapy. Social caseworkers have been busier attempting to distinguish their practice from psychotherapy than psychotherapists their practice from social casework, however, psychotherapists have defined casework more frequently than social caseworkers have defined psychotherapy.

The article proposes to examine some of the dynamics operating in a staff committees composed of caseworkers and case supervisors and their influence upon the committee's work. Also, discussions taking place between members of a committee set up to formulate a staff development program are presented. At the Baltimore Regional Office of the Veterans Administration such a committee is chosen annually. The chairmanship has alternated each year between the supervisors of the two social service groups and two additional members chosen by rotation, one from the medical and one from the psychiatric group. Structurally, this would seem to provide for the fostering of new program ideas, yet the staff obviously felt a lack of stimulation even though the program content included such diverse elements as case presentations, discussion of administrative problems, summarization and discussion of material from professional journals and addresses by guest speakers. Each successive committee seemed to have an individual quality and considerable originality, yet these did not find as much expression as one might expect.

This article focuses on the life-space management of behavioral crisis. In the later part of 1954 and early months of 1955, six boys between 8 and 11 years of age were admitted to a closed ward in the clinical center of the National Institutes of Health. From the outset their program included four hours a week of individual psychotherapy, special in-hospital school, and intensive milieu therapy with emphasis on life-space interviewing around disturbed behavior. By July 1957, these boys had improved sufficiently to move out of the closed hospital ward into a specially built halfway house, officially called the "Children's Treatment Residence." This structure was located on the hospital grounds and was designed as an intermediate stage in the boys' socialization and treatment. On Friday, February 13, staff of the halfway house announced to the boys that the residence would close that summer and they would be discharged. Some of the boys responded immediately with aggressive remarks, expressing mainly concern about leaving the residence and questions about possible placements.

Community mental health as currently considered assumes a variegated hue, depending upon the professional discipline which views it. Frankly, in most instances when there is reference to mental health at the state level, one is really referring to activities largely confined to the care and treatment of the mentally ill, outpatient as well as inpatient. As efforts of psychiatry have joined with other professional disciplines, the focus of efforts have broadened from the narrow confines of the mental hospital or the clinical psychiatrist's private office to the magnitude of being recognized as the No.1 public health problem of the U.S. concern. The recognition of and publicity attendant on the size of the mental illness problem was crystallized as a matter of national concern twelve years ago with the passage of the National Mental Health Act. Social work programs are conceived and administered through individual and interrelated agency structures which seek to meet identifiable needs of individuals and groups within geographical boundaries. Community organization as such is an integral part of the social work curriculum.

In recent years it has become increasingly apparent to professional persons in the field of social work that the needs of the public far exceed the facilities available. The public is becoming increasingly aware of the nature and implications of emotional disturbance and the part this plays in the life of the individual and of the family. Professional persons in the various helping agencies are recognizing the vast emotional implications of the problems of their clients and are concerned that those needing extensive casework or other service have this available to them. Every agency in the broad field concerned with problems of an emotional nature is faced with the question of how to balance quantity and quality, how to meet demands with services that are effective. Many agencies are making some efforts in this direction. In many mental health agencies where intensive treatment is undertaken, it has become necessary to make some estimate of success of treatment and to put effort into the selection of cases on the basis of prognosis.

This article focuses on innovations of school mental health programs that include comprehensive primary prevention and rehabilitation monitored by systematic evaluation. The prevalence of maladjustment studies should be examined by all school mental health workers. The course approach to teacher mental health training was less than convincing, although courses were shown to influence verbal statements of attitudes to make them coincide with the statements of clinicians. One source of new school mental health programs is through a redeployment and augmentation of present mental health personnel.

The development of a standardized instrument designed to measure the treatment environment of the mental hospital provided the basis for two separate works of Jay Jackson (1964, 1969). The present study is in part a partial re-analysis of this standardized instrument known as the "Characteristics of the Treatment Environment Scale" (CTE Scale). The analysis is based on a heterogeneous national sample of 18 state mental hospitals and results in the construction of a new instrument called the "Treatment Milieu Scales" (TMS). This present analysis includes shortening of the Jackson CTE instrument, the development of new factors, and a test of their predictive ability with respect to the therapeutic orientation of the treatment environment as measured by hospital effectiveness. These effectiveness measures include in-hospital indicators such as staff morale, quality of over-all care, psychiatric care, patient movement, and net release, as well as in-community measures including social adjustment, and medical (mental status) adjustment. Significant findings are obtained for the patient movement measures, while several partial correlations were found to be significant in all the other in-hospital measures except staff morale. The findings suggest the "humanistic" tradition of therapy is not necessarily the most appropriate when viewed from the perspective of in-community patient rehabilitation. [ABSTRACT FROM AUTHOR]

A sample survey using personal interviews was conducted in the Reno, Nevada, area to assess public conceptions of suicide and suicidal actions, attitudes toward the notion of suicide, attitudes toward people personally known to have committed or attempted suicide, and various degrees of familiarity with suicidal behaviors. Suicidal behavior by others was personally familiar to 74 percent of the respondents, and the general conceptions of suicide included shame and social disgrace, but not blame, to the family. Suicide generally was seen as something that happens to a person, rather than something he intentionally brings about. Public health implications of the data are discussed. [ABSTRACT FROM AUTHOR]

Every system of deviance definition and management must address three basic questions: (1) Who shall be defined as deviant and in need of management? (2) Who shall be the legitimate agents in defining and managing the deviant, and what shall be their respective roles? (3) What shall be done to or for the deviant? In contrast to both the legal and traditional mental health systems, which offer delimited responses to these questions, the community mental health system, in both philosophy and practice, offers such all-inclusive responses that it is developing into a boundaryless system of deviance definition and management. The community mental health approach unavoidably, if not deliberately, confronts and breaks down the boundaries of other deviance management systems and appropriates some of their territories. Of particular significance are the implications of these developments for the future articulation of the legal and mental health systems. [ABSTRACT FROM AUTHOR]

In a study of 1,045 state mental hospital patients released on leave of absence during the calendar year of 1956 to the Oakland California Bureau of Social Work, a large amount of evaluative information was collected on post-hospital adjustment. Data from case records, administrative files, and hospital records were reviewed. They clearly demonstrated that most ex-patients did not possess a sufficient number of social resources to allow them to adapt to the world outside the state hospital. On the basis of these findings, one can easily understand why seven out of ten of these patients returned to the hospital. [ABSTRACT FROM AUTHOR]

The present study explores socio-cultural and social-psychological factors associated with the voluntary utilization of a psychiatric outpatient clinic among students on a large university campus. Students who sought psychiatric care as compared to those who did not were (1) more likely to come from groups who were less integrated into traditional social institutions in terms of role expectations, (2) more likely to belong to or identify with other students who were more cosmopolitan in value-orientation and less integrated into the general collegiate milieu, and (3) more likely to have friends with social-emotional problems and were more likely to discuss such problems with greater frequency. [ABSTRACT FROM AUTHOR]

The article focuses on the level of mental health services offered at hospitals and health departments in the U.S. It assess the interest of health planners and administrartors in the development of mental health services. The author has identified the significant community, organization, and personal variables associated with different implementation levels. Services and activities selected for study include outpatient diagnosis, treatment services, inpatient diagnosis and treatment services, follow-up care after hospitalization, integration of mental health services with other health services and the use of indigenous workers for case-finding and information dissemination.