The chronic psychiatric patient: problems, promises and perspectives, past, present and future.

OBJECTIVE: To present an overview of the issues involving the severely and chronically mentally ill over the past 50 years and summarize new research that may aid them. METHOD: To present the problems that have faced and will face this population, the promises that have been made about and to them, and assess how well we fulfilled our promises and handled the problems. RESULTS: We have made some but not enough progress in solving the problems facing the severely and chronic mentally ill in the past and at present, but the future holds more hope if recent solid, practical, economically feasible mental health services research is translated through policy and practice into better patient care. CONCLUSION: As pessimistic as we often are about the plight of the chronic mentally ill, their future can be better if recent research is implemented.

Sabbaticals : A User's Guide.

Academic sabbatical leaves have been offered in the United States since 1880. The author discusses the historical background and rationale for sabbaticals, their evaluation, and practical tips for those planning such an academic leave.

A ten-year update of administrative relationships between state hospitals and academic psychiatry departments.

OBJECTIVE: In a follow-up to a survey ten years earlier, the authors investigated current administrative relationships between academic departments of psychiatry and state hospitals. METHODS: A 20-item questionnaire was sent to the chairs of the 110 medical school departments of psychiatry with accredited psychiatric residencies. RESULTS: Eighty-two departments, or 75 percent, responded. Seventy-one percent of the respondents reported that their department had a relationship with a state hospital; 79 percent of these relationships involved the education of psychiatric residents. Most respondents rated the quality of the relationship favorably (4 or 5 on a 5-point scale). Almost all respondents believed that residents can obtain a high-quality education in a state hospital. More than half of the departments responding to a question about the importance of a state hospital rotation rated it of major importance in their residency program. CONCLUSIONS: Many medical school departments of psychiatry remain closely involved with state hospitals and recognize the hospital as an important part of residents' education. Administrators have gained much experience about how to develop and implement mutually beneficial relationships.

Administrative relationships between community mental health centers and academic psychiatry departments: a 12-year update.

OBJECTIVE: The authors investigated the administrative relationships in 1990 between medical school departments of psychiatry and community mental health centers (CMHCs). METHOD: A 20-item questionnaire was sent to the chairpersons of the 110 medical school departments of psychiatry with accredited psychiatric residencies. RESULTS: Sixty-nine percent of the chairpersons responded to the questionnaire. Sixty-eight percent of the responding chairpersons reported that their departments had relationships with CMHCs, and 90% of these relationships involved the education of psychiatric residents. Most responding chairpersons described the quality of their existing CMHC relationships as good to excellent. In the most common type of relationship reported the CMHC was used as a setting for resident education. The vast majority of responding chairpersons stated that quality resident education is possible in a CMHC, and about two-thirds of the responding chairpersons with CMHC relationships involving residency education rated the CMHC rotation as of major importance to their residency programs. CONCLUSIONS: CMHCs continue to be an important and valued component of the educational experience for many psychiatric residents, and many departments of psychiatry have recognized the advantages and benefits of CMHCs for residency training. There are now considerable data on how a relationship between a medical school department and a CMHC should be structured to achieve maximum benefit for both the department and the CMHC.

Ensuring services for persons with chronic mental illness under national health care reform.

People with chronic mental illness present complex challenges for the design of health care financing reforms. In this position statement from the committee on psychiatry and community of the Group for the Advancement of Psychiatry, the authors describe chronic and severe mental illnesses as psychiatric illnesses that require acute and ongoing psychiatric assessment and treatment, as chronic medical diseases that require ongoing rehabilitative services, and as persistent disabilities that need ongoing supportive care and social services. Any proposal for health care reform must ensure parity of chronic psychiatric illnesses with other psychiatric conditions. It must also reimburse psychiatric rehabilitation at parity with other medical rehabilitation and provide equal access to and reimbursement for broad ancillary health services that reduce costs and improve quality of life.

State-university collaboration in psychiatry: the Pew Memorial Trust Program.

This contribution summarizes the background leading up to the goals of and the experience gained from a major national initiative to expand and improve collaborative activities between state departments of mental health and university departments of psychiatry through regional conferences, national workshops, ongoing consultations, and awards. It details the problems of the public system and how successful collaborative efforts have improved the situation, cites the role of one such a program (in Maryland), recounts the process of holding a national invitational conference and the subsequent "Call to Action," and summarizes what the Pew Project is intended to do and how the project is progressing.

E pluribus unum: striking back at disunity.

Examination of the current tendency to emphasize differences in psychiatry leads to the conclusion that there is a vast distance between those differences offering diversity and controversy that enliven and enlighten our professional lives and those born out of personal pique and intellectual obsolescence. For while diversity is essential and controversy invigorating--ideological sniping at one another is destructive, and being behind the times, downright dangerous. The title of may paper--"E Pluribus Unum"--roughly translated means "out of the many--one." It is my contention that sometimes we perceive the differing views of psychiatry as splitting us apart and destroying us, and indeed when they involve sniping and obsolescence, this may be the case. Such a view of each other is, I believe, increasing because of increasing environmental changes--in science, in corporatization, in reimbursement, and in competition. But I believe equally firmly that the solution to these changes lies in our hanging together and conducting effective, cooperative, educational, political action, and ethical activities, rather than cursing either the darkness or each other. Thus, while many wish to emphasize differences, I wish to conclude by emphasizing similarities. We are many, and that diversity and the controversy it engenders is a source of enormous strength. But we are also one, and that identity and cohesiveness can dispel the more destructive types of differences. We must make sure that we remain many, but we must make equally sure that we remain one.