Residential facilities for the mentally ill: needs assessment and community planning.

The planning and development of community-based facilities for the mentally ill have been hindered by many factors, one of which is the lack of an acceptable methodology for determining the housing needs of this population. This paper describes a consumer-oriented needs assessment strategy that provides a basis for planning residential facilities for the mentally ill. Survey results provided detailed descriptions of the population in need of residential programs, the types of facilities needed, the total volume of need for each, and the distribution of need. Implications for program planning are discussed as well as the advantages and disadvantages in utilizing this approach for establishing a basis for residential facilities planning for the mentally ill.

A non-neuroleptic treatment for schizophrenia: analysis of the two-year postdischarge risk of relapse.

The efficacy of antipsychotic drug maintenance in reducing the risk of relapse among previously hospitalized schizophrenic patients has been well documented. However, data from an ongoing study comparing two cohorts of young first admission schizophrenics--one receiving neuroleptic-oriented treatment on the wards of a community mental health center (CMHC), the other an intensive interpersonal approach in a small homelike facility in the community (Soteria House)--raise questions about the routine use of neuroleptics with this population. Our questioning of this practice is based on data analyzed from these two cohorts by means of the life table, a statistical technique appropriate for longitudinal studies. Data are presented in two ways: (1) The overall effectiveness of the two independent treatment programs (Soteria, N = 32, vs. CMHC, N = 36) is compared in terms of the probabilities of not being readmitted over the 2-year postdischarge interval. (2) Analyses that look at the influence of the original treatment setting and postdischarge antipsychotic drug status on readmission rates are presented. Program comparisons reveal Soteria patients to have a consistently higher survival rate than CMHC patients throughout 2 years postdischarge. At 12 months postdischarge, the cumulative probability of remaining well (no readmissions) significantly favors the Soteria patients (p less than .05, Mantel chi2). The overall results of the Soteria program were achieved despite the fact that all CMHC patients received neuroleptics during their original inpatient stays and about 50 percent were maintained on neuroleptics up to the point of readmission or study termination, whereas only 10 percent of Soteria subjects were treated with or maintained on neuroleptics. The survival rates by postdischarge drug status and program affiliation show the Soteria no-drug group to have the highest proportion of survivors at almost every interval throughout 24 months, the CMHC drug-maintained group to have the lowest survival rate, and the CMHC unmaintained group to be surviving at a rate generally comparable to the Soteria no-drug group.

Community residential treatment for schizophrenia: two-year follow-up.

Two-year outcome data from a study comparing two kinds of treatment given similar groups of young, newly diagnosed, unmarried schizophrenic patients deemed in need of hospitalization are reported. The experimental program, Soteria, is a nonmedical, psychosocial program with minimal use of antipsychotic drugs; it is staffed by nonprofessionals and located in a home in the community. The control program is a short-stay, crisis-oriented inpatient service in a community mental health center where neuroleptic drugs are the principal treatment. The experimental group had significantly longer initial stays, and only 8 per cent received neuroleptics during their initial admission. Over the two-year follow-up period, there were no significant differences between the groups in readmissions or levels of symptomatology. However, experimental subjects significantly less often received medications, used less outpatient care, showed significantly better occupational levels, and were more able to live independently.

Being with madness: personality characteristics of three treatment staffs.

The personality characteristics of the nonprofessional staff of Soteria House, an innovative residential treatment program for schizophrenics, are assessed and compared with characteristics of representative staffs from two more traditional mental health programs for schizophrenics: a university psychiatric ward and a community-based program staffed by a specially trained group of state hospital aides. A battery of self-report personality questionnaires was used. Analysis of the data indicates an over-all similarity of personality profiles in the three groups. All groups demonstrated two sets of characteristics considered desirable for therapists of schizophrenics: the ego-strength qualities of self-assurance, emotional maturity, independence, and autonomy, and the affective qualities of warmth, sensitivity, and empathy. However, within a third set of characteristics, descriptive of cognitive-attitudinal qualities, the Soteria staff possessed significantly more intuition, introversion, flexibility, and tolerance of altered states of consciousness. The authors speculate that it is this last set of characteristics that allows the Soteria staff to function in the program's intensive, unstructured treatment environment.