III. Deinstitutionalization and the Revolving Door

In the 1960s, there was a change in the treatment of mentally ill patients. The locations for treatment of mentally ill patients changed from inpatient institutions to community-based facilities that emphasize outpatient care. On the surface, this sounded like a great idea - bring ill patients colder to the community, help them learn to function in society, don't treat them as though they are "ill", open up beds in hospitals for physically ill people, etc. But how good was this change?

This type of shift was made possible by:

1. Emergence of effective drug therapies

2. Development of community based mental health centers

The shift has been tremendous:

1955: approximately 1/3 of all hospital patients were mentally ill

Today: approximately 1/4

this does NOT mean that hospitalization is a thing of the past. More focus on local and community based centers.

A. HAS THIS BEEN GOOD???

1. Positives:

a) many have avoided unnecessary hospitalization

b) institution treatment has improved

c) rates in institutions have been reduced

2. Negatives:

a) many severely ill patients released with nowhere to go

b) those released supposed to get help from halfway houses and shelters - but most of these were never built.

c) federal funding has diminished....no services

B. REVOLVING DOOR PROBLEM

refers to patients being released from institutions, then return, then released again. WHY?

1. While in institutions patient may respond well to medication

2. Once stabilized, they no longer qualify for financial assistance....released

3. Community-based services not provided adequate funding, so these patients don't get enough assistance....thus, they digress and end up back in institution

Some facts:

* studies have indicated that approximately 50% of those released from public mental hospitals were readmitted in 1 year

* Over 2/3 of all psychiatric inpatients are former patients

* one result has been massive homelessness of those suffering from mental illnesses

Word list:

• Therapist – лікар, фізіотерапевт

• underlying – той, що лежить в основі

• premise - вищезгадане

• advantages - переваги

• precisely - точно

• addition - доповнення

• therapeutic - терапевтичний

• demon - демон

• possession - власність

• dysfunction - дисфункція

• archaic views – застарілі погляди

• sin - гріх

• commit - виконати

• witchcraft - відьмацтво

• mental facilities – притулки для душевнохворих

• prisons - в’язниця

• restrain – обмежувати, стримувати

• chains - ланцюги

• restraint jackets – гальмівна сорочка

• padded cells – палата оббита повстю

• sick - хворий

• confine – ув’язнити

• public - громадський

• infection - інфекція

• paresis – парез (напівпараліч)

• caused - спричинений

• finding - знахідка

• organic - органічний

• era - ера

• utilizing - використання

• drugs treatment – медикаментозне лікування

• diverse – різний, інший

• integral – дещо ціле

• seek – звертатися, добиватися

• severity - суворість

• alter - відрізнятися

• prompt - підказати

• suicidal - самовбивчий

• hallucinating - галюцинація

• marital conflict – сімейна сварка

• picking - відбір

• time management – впорядкування часу

• provide - забезпечити

• assistance - допомога

• struggle - боротися

• regular - регулярний

• daily life – щоденне життя

• parenting - батьківство

• relationships - відносини

• agoraphobia – страх перед відкритим простором

• divorce - розлучення

• magnitude – величина, важливість

• in need – в скруті

• insight – раптовий здогад, інтуїція

• pioneer - першовідкривач

• engage – залучати, втягувати

• lengthy - довгий

• interactions - взаємодія

• difficulties - труднощі

• direct - прямий

• maladaptive - неадекватний

• procedure - процедура

• operant conditioning – реабілітаційна терапія

• association - асоціація

• relaxation - розслаблення

• medical - медичний

• remedy - лікарство

• create - створювати

• manic - маніакальний

• swing - коливання

• euphoria - ейфорія

• correct - виправляти

• imbalance – невідповідність, дисбаланс

• clinical - клінічний

• counsel - консультувати

• prescribe - виписувати

• psychiatrist - психіатр

• physician - терапевт

• psychoanalysis - психоаналіз

• conscious - свідомий

• unconscious - несвідомий

• observable - помітний

• present - представити

• filtering of thoughts – фільтрування думок

• dream - сон

• analysis - аналіз

• free association – вільна асоціація

• content - зміст

• latent - прихований

• manifest - відкритий

• interpretation - тлумачення

• acquired - набутий

• figure out – вичислити, зрозуміти

• transference – перенесення, переведення

• spouse – чоловік чи дружина

• sign - знак

• right track – правильна дорога

• hinder - мішати

• similar - схожий

• resistance - опір

• block - блокувати

• painful - болючий

• determining - визначний

• hurt - болить

• crucial - критичний

• deeply - глибоко

• buried - похований

• occur - траплятися

• cleverness - розумність

• rely - довіряти

• demonstrate - демонструвати

• inconsistency - протиріччя

• incongruence - невідповідність

• self-concept - самоконцепція

• contradictory - суперечливий

• feedback - віддача

• explore - досліджувати

• genuineness - щирість

• nonjudgmental - неосуджуючий

• empathy – емпатія, співпережиття

• point of view – точка зору

• despise - зневажати

• physical abuser - ґвалтівник

• judging - оцінка

• rephrase - перефразувати

• mirror - дзеркало

• regard – відношення, увага

• positive - позитивний

• acceptance - прийняття

• clarify - прояснити

• assumptions – припущення, прийняття на себе

• product - результат

• desensitization – відновлення нормального психічного здоров’я

• counterconditioning – стимулювання заміни небажаної реакції бажаною

• hierarchy - ієрархія

• comfortable - зручний

• move on – рухатися далі

• aversion - відраза

• aversive - відразливий

• stimulus - стимул

• elicit - виявити

• undesirable - небажаний

• vomit - блювати

• smell - запах

• emotive - емоційний

• irrational - ірраціональний

• get rid of - позбутися

• turmoil – безпорядок, метушня

• sincere - щирий

• approval - схвалення

• significant - важливий

• competent – достатній, компетентний

• adequate – достатній, адекватний

• achieving - досягнення

• catastrophic - катастрофічний

• awful – жахливий, огидний

• terrible - страхітливий

• horrible – страшний, жахливий

• monitor – контролювати, радити

• self-control - самоконтроль

• replace - заміщати

• error - помилка

• achieve - досягати

• pessimism - песимізм

• blaming - звинувачення

• location - розміщення

• patient - пацієнт

• inpatient – стаціонарний хворий

• institution - заклад

• deinstitutionalization – демонтаж промислових закладів

• revolving door – повторний цикл

• community-based – общинний, груповий

• facilities – обладнання, об’єкти

• outpatient – амбулаторний хворий

• care - турбота

• surface - поверхня

• society - суспільство

• emergence – поява, вихід

• approximately - приблизно

• unnecessary - необов’язково

• improve - вдосконалити

• halfway house - санаторій

• shelter - притулок

• diminished - применшувати

• service - служба

• release - звільняти

• stabilize - стабілізувати

• qualify - готувати

• funding - фінансування

• digress - відходити

• readmit – знову прийняти

• massive - великий

• homelessness - безпритульність

Ex 1. Translate the following sentences into Ukrainian:

• Not so long ago, it was believed that demons or possession were the causes of psychological dysfunction.

• The early forms of mental facilities were basically prisons, in which patients/prisoners were restrained with chains, restraint jackets, and padded cells.

• Drugs have become an integral part of therapy, but we now have talk therapy, behavioral therapy, cognitive therapy, and others which can be used in combination or in the place of drug therapies.

• As you can see, all the approaches have some element of "associations" - meaning the therapist tries to change negative associations into more positive ones.

• The main idea behind psychoanalysis is that there is a constant struggle between the conscious and unconscious, which often results in maladaptive behaviors, problematic, conscious thoughts, etc.

Ex 2. Answer the following questions:

• What do you know about the archaic views on the causes of psychological dysfunction and the early forms of mental facilities?

• Name several issues that prompt people to seek therapy.

• What Exactly is psychotherapy?

• What types of treatment are available?

• Who provides treatment?

• What techniques may a psychoanalyst use to identify the underlying issues?

• How does the Rogerian therapy differ from the therapist dictating the pace and direction?

• The premise of systematic desensitization is to reduce the client's anxiety responses through counterconditioning. Make an example of it.

Ex 3. Say whether the following is true or false:

• Aversion Therapy involves having the client associate an pleasant stimulus with a stimulus that elicits an undesirable response or action.

• Rational Emotive Therapy attempts to rid individuals of irrational beliefs, because most problems caused by irrational thoughts that lead to emotional turmoil.

• In the 1960s the locations for treatment of mentally ill patients changed from outpatient institutions to community-based facilities that emphasize inpatient care.

• Revolving door problem refers to patients being released from institutions, then return, then released again.

• Studies have indicated that approximately 50% of those released from public mental hospitals were readmitted in 13 years.

Ex 4. Complete the sentences with the following words:

Imbalance, personality, treatment, physical infection, mentally, witchcraft, therapists.

• Trained, qualified ___, however, have some advantages since they learn precisely how to help those in need.

• However, in 1905 it was discovered that General Paresis was caused by a___ (syphilis), rather than by ___or demonic possession.

• In 1940s began the era of utilizing drugs for ___of mental illness.

• People often think that you must be really ___ ill or "out of it" to seek help from a psychologist or other expert, but this is not true.

• Manic depression is a chemical ___ in the brain that cause a person to swing from states of euphoria to states of depression.

• Any observable symptoms of an illness or problem are signs of conflict between different aspects of ___(i.e., struggle between the id, ego, and superego).