Psychogeriatric hospitalization: terminable or interminable?

This paper takes issue with the stereotype of psychogeriatric patients in the general hospital using beds unnecessarily. With appropriate organization of services involving integrated teamwork, comprehensive patient assessment, early discharge planning and liaison with community resources, a positive outcome and early discharge was achieved with the majority of a group of psychogeriatric patients.

Supportive housing: a consumer evaluation study.

The current debate about how to provide housing for persons with persistent psychiatric disabilities should be informed by empirical information from a variety of sources. Data from a study of 17 residents discharged from Regeneration House Inc., illustrates the value of consumer perceptions in the evaluation of supportive housing. Extensive exploration of the positive and negative aspects of living in a group home from the perspective of experienced residents provides useful input for programme planning. The implications of the findings for the individual programme and the wider field are discussed.

Legal issues in the care of mentally impaired elderly persons: competence, surrogate management, and protection of rights. Working Group on Legal Issues, Committee on Guidelines for Comprehensive Services to Elderly Persons with Psychiatric Disorders.

This article identifies a number of areas of concern in the care of mentally impaired elderly persons, focusing on the need for improved criteria, definitions and procedures in the following areas: the determination of competence or incompetence; the initiation, implementation and monitoring of measures for surrogate management (power of attorney, trusteeship, guardianship); standards of care; and advocacy in defence of the rights of elderly persons. The large and growing number of elderly persons in need of care--the very old, the frail, those without relatives and, in particular, the mentally impaired--has many legal implications. The critical issue is how effectively the law can protect and maintain the rights of people who are unable to do so themselves.

Social disability in chronic psychiatric patients.

The authors measured the social functioning of 147 chronic psychiatric patients using a rating scale originally devised for use with the mentally retarded, the Adaptive Behavior Scale (ABS). They found that social deficits were more widespread and generally more severe among chronic psychiatric patients than among institutionalized mentally subjects. Chronic undifferentiated schizophrenic patients showed the most comprehensive deterioration; other groups, such as neurotic patients, women, and the elderly, had more limited impairments. The authors suggest that the ABS can be useful in establishing the limits of social functioning of chronic psychiatric patients.

Alternatives to the mental hospital: use of residential facilities for long-term psychiatric care.

We examine the use of the mental hospital and alternative residential facilities by 149 chronic psychiatric patients in Ontario. All major movements of patients since the time of first admission were recorded, including the number of episodes and duration of hospitalization and placement in alternative facilities and in the community. Clinical and social variables thought likely to influence use were correlated with duration, placement, and mobility. In spite of the lack of formal criteria for placement, relatively discrete and homogeneous populations were found in each facility and clear patterns of use could be distinguished. For many patients, their present placement represents their most typical setting and implies a particular route through the psychiatric services. We describe factors relating to different types of movements, and emphasize the continuing importance of the mental hospital in long-term psychiatric care.

Long-term psychiatric care in Ontario: the Homes for Special Care Program.

During the last decade in Ontario large numbers of patients with chronic psychiatric disorders have been discharged from the mental hospitals and are now scattered throughout other psychiatric facilities. The Homes for Special Care Program offers privately run but government-funded accommodation for severely disabled patients with relatively stable and socially acceptable behaviour, who require residential or nursing care but are thought unlikely to benefit from further hospital treatment. Salient features of the program include the formal discharge of patients from hospital and their legal reinstatement as "persons", the cessation of active psychiatric treatment, and the provision of ongoing care and supervision by largely untrained personnel. Medical care is provided by general practitioners and the program looks to volunteer agencies to provide recreational and other activities for residents.