A combination of crisis theory and role theory is proposed as a useful conceptual approach to the rehabilitation of those individuals suffering from chronic mental illness.Only recently has the plight of the chronic mental patient in the community been publicly acknowledged by mental health professional organizations and selected segments of government. Delayed recognition occurred because deinstitutionalization appeared at first to be successful. The population of state hospitals declined.Witness the State of California. The number of state hospital beds dropped from 37,000 in 1958 to less than 5,000 in 1980. Patients were deinstitutionalized. They were in the community, but there were few if any treatment programs available for them. This was so despite the fact that some money followed the patients into the community from the state hospitals, but not enough. At 1980 cost (i.e., adjusting for inflation and population growth), the state hospital cost of 1958 would be two billion dollars. In 1980, the state mental health budget, including state hospitals and community programs, was 578 million, 29% of what would have been spent if the state hospital system had been maintained at the 1958 level.In addition, the federal government established and funded community mental health centers beginning in the early sixties. But as was pointed out by Chu and Trotter (1974) many years ago, the chronic mental patient was not the focus of the new centers. Monies were spent on new problem areas and new target groups to the detriment of the chronic patient.
Rejection of the Chronic Mentally IIIThe above introduction emphasizes two points. First, there was never This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
An innovative application of consultation to community care facilities, also known as board and care homes, is presented in order to improve services to chronically mentally ill persons. An extended Caplanian model for establishing an effective consultant-consultee relationship with administrators is described with reference to the following tasks: (a) understanding the setting; (b) recognizing an unmet need; (c) resolving problems of entry; and (d) negotiating a contract for case consultation and for program consultation. Interventions that reduce theme interference with work efficiency are described by examining realistic conflict resolutions utilizing problem clarification, expressing understanding, sharing feelings, and exploring solutions. The results include development of a climate of responsibility among the chronically mentally ill residents and more effective use of community resources.
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