In lieu of an abstract, here is a brief excerpt of the content:

28 men in Diapers Once again my suspicion had been confirmed. During a previous, official visit to this facility my staff and I had been proudly shown the list of program activities and had even (with patients’ permission) sat in briefly on a group therapy session. Now I discovered to my dismay that programming was often the exception, not the rule—despite the daily posting of planned activities. The facility director “moved on” shortly thereafter, and the department’s staff and I searched far and wide until we found a new person who specialized in hospital “turnarounds” to head up the facility. This got the attention of leadership throughout the Department of Mental Health and led to a new openness to innovation. Shortly thereafter, several of the facility directors collaborated to implement an innovative and newly developed concept—the “treatment mall.” A mental health treatment mall is designed to provide a selection of needed services and supports each day in a central place so that patients can go easily from area to area to find the treatment they need. This might involve training in social skills or hygiene, help in picking out new clothes and managing one’s wardrobe, work with an anger management group, individual psychotherapy, or vocational training. Each morning the patients come to the treatment mall and are helped to select whatever is most appropriate for them, which varies depending on each person’s progress. So for instance, a patient might end up working on social skills and hygiene and clothing, then on anger management, and then on vocational training before being discharged. The various programs are offered by staff trained in that area, with sensitivity to individualizing the training to meet each person’s need. After the allotted block of time has been used, the patients move on to their next “appointment.” Although this may require more staffing or new skills compared with custodial care, it is not inordinately expensive, since most staff can be easily retrained in these areas. The goal is for hospitalization to be marked by intensive and effective treatment, which also makes it more likely that the patient may be successfully discharged after a shorter-than-average stay. Thankfully, the average length of stay in psychiatric hospitals is decreasing and is now typically measured in days or weeks rather than months or years. Treatment malls are not the solution to every facility problem, but they go a long way toward filling the void of use of time that is too often met with overmedication and TV. Nobody is left behind in his or her room, and nobody wastes the day away with television. Instead, everybody who is physically and emotionally capable joins in the treatment men in Diapers 29 mall experience each day. In this way, daily programming is not just a theoretical list of activities on the wall. It is built into the facility’s daily structure—both physical and programmatic. It should be noted that for hospitalization to succeed, planning for rehabilitation and recovery in the home community must begin long before discharge. There should be a smooth transition from brief hospitalization to intensive community care, which requires careful preparation and ongoing liaison with community services. Persons with serious mental illness who are hospitalized against their will have the right to receive effective treatment, not just custodial care while medications are stabilizing, and to be returned to their home communities for effective follow-up care as soon as possible. Anything less is unethical, risky for the patient, unnecessarily burdensome on their family, and costly for the community that is deprived of a functioning citizen. It is time to transform America’s broken system of mental health care. less severe mental Health needs and community Resources Before proceeding, it is necessary to take a look at how less severe mental health needs should be met. If they are not to be included in the same category as serious mental illness, must they then be ignored altogether? Although the needs of individuals with serious mental illness should be met on a priority basis, those who suffer less severe needs must by no means be ignored. A compassionate society must assist all of those in need and should provide timely resources that can prevent less severe mental health problems from spiraling out of control. Without social support, for example , a person suffering bereavement is all the more vulnerable for a major depressive episode. Put another way, if a person’s support network is...

Share