Another view of autonomy: arranging for consent in advance.

A review of the issues surrounding a Ulysses contract--a prior consent agreement--juxtaposes the autonomy expressed by a stabilized patient who gives consent in advance for treatment during an acute break and the exercise of a patient's right to refuse as protected by legal advocates. Ideally, the first approach would enable persons to claim control over their lives and promote a collaborative process involving patient, family members, and professionals. But feedback from an informal canvassing of individuals representing various vantage points emphasizes concern about safeguards and monitoring the use of these contracts. Although several legal avenues may be open, both theoretical and technical obstacles can block the road to voluntary involuntary treatment. We hope this article will serve as a stimulus for an open exchange about ways to ensure one's right to protect oneself from the consequences of psychosis.

Toward a new alliance : psychiatric residents and family support groups.

In an attempt to assess the status of residency training in psychoeducational approaches for families of chronically ill patients, the authors conducted a national survey of U.S. residency training programs. Responses from 154 programs (75%) indicated a wide variation in time allotted, activities, and participants in such training among the respondents. Less than 50% of the programs indicated formal involvement of family support groups such as the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manie-Depressive Association (NDMDA). The authors describe a program they have initiated that incorporates organized family support groups in such training efforts.