Jaak Rakfeldt

The roots of the recovery movement in psychiatry

The roots of the recovery movement in psychiatry : , The roots of the recovery movement in psychiatry : , کتابخانه دیجیتال جندی شاپور اهواز

The Experiences of Long-Stay Inpatients Returning to the Community

THE authors of this engaged and engaging account of the return migration of 12 individuals to a community after prolonged confinement make an important move when they infuse a policy debate with the experiences of former psychiatric inpatients. Researchers and clinician-administrators now seem to be asking with increasing frequency for the views of service recipients or users; however, one is less sanguine about how well we listen to or act on those views. Mental health policy debates and decision making have for some time been informed by individual stories and experiences, but these have been largely conveyed by and from the perspective of outspokenly disappointed family members and consumer activists. Davidson and colleagues take us a significant step further by providing information from a more representative, albeit small, constituency. As importantly, they listen. In a research environment tyrannized by large samples assembled to quench the thirst for causal modeling and statistical analysis, this paper reminds us that validity deserves as much respect as reliability, that understanding does not necessarily involve regression coefficients and chi squares.

Outreach Workers' Experiences in a Homeless Outreach Project: Issues of Boundaries, Ethics and Staff Safety

Mental health professionals and researchers have emphasized the importance of conducting outreach to locate homeless persons with mental illness, and of creatively engaging these persons into a therapeutic relationship. These outreach and engagement activities raise challenging issues in the areas of client-staff boundaries, professional ethics, and staff safety. While several issues in each of these three key areas have received attention in the growing literature on homelessness, certain issues within each area remain unexplored. The authors draw from the street experiences of outreach staff in a federally funded homeless outreach project to further explore each of these areas, and suggest that experiences of outreach workers are essential in shaping and redefining work activities in these, and other important areas.

Normalizing acute care : A day hospital/crisis residence alternative to inpatient hospitalization

Normalization is the use of culturally valued means to enable people with disabilities to live culturally valued lives. In this article, the authors describe an effort to bring normalization practices to acute psychiatric care. They describe a day hospital/crisis respite diversion program that serves as an alternative to acute inpatient hospitalization and sketch the research project that fostered it. The authors argue that a day hospital/ crisis respite provides effective clinical care comparable to inpatient hospitalization but achieves greater potential for recovery through a normalizing philosophy and practice. An implication of this finding is that such programs based on the principle of normalization may be both cost effective as well as more empowering for patients.

Can digit symbol-verbal fluency comparisons facilitate detection of pseudodementia? A preliminary study.

Depressive psychomotor retardation may impair performance on timed tests. By comparison word association measures of verbal fluency are reportedly unaffected by depression. Comparisons of a brief psychomotor test with a measure of verbal fluency may therefore prove useful when there is a concern that depression may be undermining adaptive functioning, assuming both measures display: (1) broad-spectrum sensitivity to brain impairment, (2) differential vulnerability to depression, and (3) moderate correlation in nondepressed persons. Digit Symbol (DS) and the “FAS” measure of verbal fluency are sensitive to genuine dementia, satisfying the first criterion. We found that depressed schizophrenics performed at significantly lower levels on DS, but not on FAS, than nondepressed schizophrenics. The two groups differed significantly on a discrepancy score derived by subtracting FAS from DS scores; normals obtained discrepancy scores highly similar to those of nondepressed schizophrenics. As the normals had higher DS and FAS scores, this discrepancy-score similarity suggests that this index may have wide application. The third criterion is satisfied by the findings of a 0.64 correlation between DS and FAS scores adjusted for age (DS and FAS) as well as gender and educational attainment (FAS) in nondepressed samples. Implications for further research and clinical applications are discussed.

Development of the citizens measure into a tool to guide clinical practice and its utility for case managers

ABSTRACT A measure of citizenship was developed and validated by Rowe and colleagues (O’Connell, Clayton, & Rowe, 2017). The items clustered around the 5 Rs of citizenship as defined by Rowe et al.: relationships, rights, resources, roles, and rights, and a sense of belonging. Although a measure has its utility in clinical settings, to address time constraints and other administrative burdens expressed by providers in their day-to-day practice, a citizens tool was developed as a practical way that providers can enhance dialogue between providers and clients on citizenship for clients served in mental health and criminal justice reentry settings. This article describes the development of the tool, testing of the tool’s utility with case managers, and implications for practice.