Leon J. Epstein

Antisocial behavior of the elderly

Abstract The elderly offender has only rarely been a subject of study, and relatively little has been written about him other than what is given in annual arrest and prison reports. The present study investigated the frequency and causes of arrests in San Francisco of individuals 60 years old or older, and certain characteristics of those arrested. Interviews were conducted with a sample of persons arrested for drunkenness. The data reported here do not include follow-up studies of the individuals arrested indicating whether they were brought to trial, acquitted or convicted, or data concerning their eventual disposition. Two types of data will be discussed. First, certain limited information was obtained for every person 60 years of age or over arrested during a period of four months during 1967–1968. Permission was obtained from the San Francisco Police Department to obtain data from the City Jail Arrest Ledger, which contains for every person arrested (over 18 years of age), name, address, sex, age, and charge. It should be noted that the United States Census1 reveals that San Francisco is somewhat unusual in the age distribution of its population, in that 18.5 per cent of its total population (780,000) is 60 years of age or older, whereas for the state of California this figure is 12.5 per cent and for the United States as a whole, 13.4 per cent. Second, a randomly selected sample of persons aged 60 or older arrested for drunkenness was interviewed. A member of the project staff who identified himself as being associated with the Langley Porter Neuropsychiatric Institute and the University of California Medical Center requested permission of each prisoner to interview him. Only two persons declined to be interviewed, although many refusals were anticipated both by the police and by members of the study team. The Uniform Crime Reports for 19672 indicate a total of 4.2 million arrests of persons 18 years of age or over in the United States in 1967, from about 4566 arresting agencies concerned with a total population of about 146 million. Of these, 225,510, or 5.4 per cent of the total arrests, were persons 60 years of age or older. In San Francisco, it was found that during all of 1967 there were 2429 arrests of persons 60 years of age or older, which amounted to only 5.3 per cent of all persons 18 years of age or older arrested in that period, despite the relatively larger proportion of elderly resident.

PREDICTORS OF SURVIVAL IN GERIATRIC MENTAL ILLNESS DURING THE ELEVEN YEARS AFTER INITIAL HOSPITAL ADMISSION

In 1959, a study was made of 534 patients aged 60 or older admitted to the psychiatric observation ward of the San Francisco General Hospital. In a two‐year follow‐up period it was found that orientation, performance on the Wechsler Adult Intelligence Scale, and ability for physical and social self‐maintenance were favorable prognostic signs.

Increasing learning during the psychiatric residency.

P OSTGRADUATE TRAINING in the field of psychiatry is currently in a state of flux, with vany fronts. Most institutions offering psychiatric residency training programs are in the process of painful reevaluation and change, attempting to integrate into their core curricula the disparate models associated with psychoanalytic psychology, community mental health, behavior modification, psychopharmacotherapy, family therapy, and a host of other models that reflect special interests of individual training centers. This situation was clearly apparent in a “white paper” of the Association for Academic Psychiatry’ which resulted from the 1973 meeting of Career Teachers in Psychiatry examining the goals, methods, and effectiveness of psychiatric residency training programs in the United States. In attempting to answer the questions, “What is a psychiatrist now? What should he be in the next decade?” it was stressed that the psychiatrist has and probably will continue to have multiple roles. He must not only have knowledge of prevalent theories of personality development and sociocultural determinants of behavior and of how to diagnose patients according to a descriptive nosology, but also know how to relate these to a theory of psychopathology. The Career Teacher Group specified that the psychiatrist should be able to do the following: “(A) He should be able to use the somatic therapies, including ECT and psychopharmacological agents. (B) He should know how to practice the various psychotherapies. He should be skilled in the forms of individual therapy in current practice that have some validity and be able to apply this ability to individuals and to work with larger social units. Training in individual therapy is essential; training in group therapy, family therapy, and behavior modification are desirable

Psychiatric consultation through continuing education in correctional institutions.

Abstract It is only recently that courts have seriously turned their attention to the constitutional rights of prison inmates for medical and psychiatric treatment. Reflecting this attention, there has been a significant increase in the number of mental health professionals working in correctional facilities, a development described by Nassi. 1 Many of these professionals encounter difficult conditions in their work environment: overcrowding in the institution; punitive rather than therapeutic attitudes; inadequate facilities for clinical work; and a shortage of other mental health personnel to help with the large amount of work. 2,3 Many of them also face perplexing and weighty decisions in their work: assessing whether an inmate is a danger to himself and/or others; assessing whether an inmate has the capacity to be law abiding if released on parole; deciding what is the most suitable treatment for a particular inmate; and advising custody personnel on how to manage inmates who are disruptive to others. Furthermore, working in correctional facilities presents the treaters with a special set of ethical and social concerns 4,5,6 that not only contribute to their need for help in making decisions but their need for support in facing the invevitable dilemmas of these settings. Help for the helpers in correctional institutions is clearly needed. In this paper, we will describe one approach to helping the helpers in correctional institutions through psychiatric consultation. This psychiatric consultation has an unusual format—it is provided indirectly through Continuing Education sessions with mental health personnel working in correctional facilities. This approach is well suited to meet the particular characteristics of the correctional work environment. Here we shall describe this approach, its multiple functions, and how it compares with other types of psychiatric consultation in other settings.