John N. Hall

Token economy systems: Breakdown and control ☆

Abstract Attention is drawn to the relatively high rate of breakdown of token economy programmes, and the reasons for this are considered. Reference is made to the results of a questionnaire circulated to British token economy programmes. Reasons for breakdown are considered in five categories, these being: nonexistent or poor patient selection; inadequate selection and training of nursing and ward staff; lack of definition of the functions of the supervising psychologist; poor co-operation from, and communication with, administrative staff; and active interference by the community. Solutions to these problems are suggested. The value of alternative or additional theoretical frameworks in promoting positive control of token systems is discussed.

Ward rating scales for long-stay patients: a review

Twenty-nine published ward rating scales for long-stay psychiatric patients are reviewed according to a standard set of criteria. Attention is paid to details of the rating setting, the rating procedure, and scale construction and evaluation, and some detailed recommendations are made. Only 4 scales meet a subset of 5 minimal criteria.

A review of the applications of the REHAB assessment system

In the last 10 years, as part of the push towards greater community provision of services for the psychiatrically disabled in the UK, assessment has assumed a prominent position. A variety of different assessment instruments have been employed, including assessment of patient attitudes and opinions, of the environment, social networks and basic living skills (Carson, 1991; TAPS, 1992). Amongst the differing assessment types, behaviour rating scales have a distinct contribution. They are particularly applicable to group settings such as hostels or hospital wards and have the advantage of being objective, behavioural, able to measure change in functioning over time or due to some intervention; and most importantly, they yield numerical scores which can be assessed against “hard data” in the form of norms or scores from other populations, especially those from other countries.

INITIATIVES IN LONG-TERM RESIDENTIAL CARE

The nineteenth century saw an explosion in the growth of public provision of residential facilities for the physically and mentally sick. Earlier centuries had seen small-scale provision of private infirmaries and asylums. Yet both types of institution grew in the nineteenth century at a larger rate than the rate of population growth, and the size of individual institutions grew during the century, so that, for example, the average size of British public lunatic asylums grew from 116 in 1827 to 1,072 in 1910. Arising from this rich provision of buildings, care of the physically and mentally ill has been dominated by hospital provision, so that hospital medicine rather than community medicine, has been historically the high status branch of the profession.