Uri Aviram

Community care of the seriously mentally ill: Continuing problems and current issues

The crisis in community care for the seriously mentally ill (SMI) stems from organizational and financial difficulties as well as from deeply embedded structural factors. The analysis shows a preference for medicalizing and individualizing the problems of SMI rather than viewing them as structural social welfare issues. The author discusses problems of deinstitutionalization, homelessness, service provisions, financing, accounting and reporting, employment, bureaucratic skimming and burden to families and points out the ambivalent ideology and the inherent contradictions within the mental health service system. Finally, the centrality of social control and the maintenance of orderly social life in public, policy and program development is illuminated.The crisis in community care for the seriously mentally ill (SMI) stems from organizational and financial difficulties as well as from deeply embedded structural factors. The analysis shows a preference for medicalizing and individualizing the problems of SMI rather than viewing them as structural social welfare issues. The author discusses problems of deinstitutionalization, homelessness, service provisions, financing, accounting and reporting, employment, bureaucratic skimming and burden to families and points out the ambivalent ideology and the inherent contradictions within the mental health service system. Finally, the centrality of social control and the maintenance of orderly social life in public, policy and program development is illuminated.

Involuntary outpatient commitment in Israel: Treatment or control?

replacing the MentalHealth Act of 1955. The new Act has been considered by legislators and professionals alike asmoreprogressiveandhumanethantheearlierlawsinceitincludedbettersafeguardsforpatients’rights.Also,ithasbeenseenasreflectingtheadvancementthroughouttheworldofpsychiatricknowledgeaswellaschangesinthedeliveryofmentalhealthservices(Kanter&Aviram,1995).The seemingly advanced approach of Israel’s 1991 Treatment of Mental Patients Act isreflected in the introduction of new legal procedure which provides for involuntary outpatientcommitment(hereinafterreferredtoas‘‘IOC’’).Thisprovisionenablesdistrictpsychiatrists

The changing role of the social worker in the mental health system.

ABSTRACT The purpose of this paper is to discuss the role of the social work profession in the mental health service arena. It analyzes the changing mental health environment and the challenges facing social work. It stresses that the profession must adapt to the dramatic changes that have been taking place since the advent of deinstitutionalization and the need for community care for mentally ill persons. Historical analysis of the social work profession shows that its involvement in the mental health field has started during the early stages of the development of the profession. Psychiatric social work has been considered a prestigious area of practice within the profession. Historically, social workers in the mental health field rarely challenged the dominance of the psychiatric profession. This position seems to have restrained social work from providing its full potential contribution to this field of practice and to the population it served. Assessment of the continuing problems and current issues of the mental health system shows the potential central role of social work in this area. However, changes must take place in the practice of social workers in the mental health service system, as well as in the education and training of social workers. The paper discusses factors that facilitate or hinder the profession from appropriately adapting to the current service needs of the mentally ill persons, their families and communities, providing quality mental health and social services to this population and society as well.

Discharge-ready patients who remain hospitalized: A re-emerging problem for mental health services

There is evidence that mentally ill patients nationwide are retained in state hospitals in spite of the fact that they are discharge-ready. New Jersey provided a unique opportunity to study this phenomenon, since it had been using specific procedures to identify discharge-ready patients in state hospitals. An analysis of New Jersey state hospital data found that about 45% of the state hospital patients were designated by either the legal or the clinical system, or both, as discharge-ready. Although a substantial number of these patients were, disabled, they were assessed as being able to manage in the community with appropriate support. Characteristics and service needs of these patients are described, and the differences between those designated as discharge-ready and those who were not are examined. Recommendations are made for future research addressing the legal, clinical and social processes that affect discharge readiness.

The Reform of Rehabilitation in the Community of Persons with Psychiatric Disabilities: Lessons from the Israeli Experience

Purpose is to present the mental health rehabilitation reform enacted in Israel in 2000, and to analyze the challenges it faces in its second decade of implementation. Lessons are drawn with regard to other jurisdictions interested in reforming mental health services. Besides reviewing the reform’s accomplishments and its contribution to the changes that have occurred in mental health services, the article also assesses the dangers it has to contend with. Analysis focuses on the system’s clients, budget, personnel and services—and on its functional environment. During the past decade, the rehabilitation services have considerably expanded. However they cover only about one-fifth of the target population. Paper discusses the mutual dependency between the rehabilitation services and the recently implemented (mid-2015) mental health insurance reform, emphasizing the importance of the rehabilitation system’s efficient and effective functioning to the success of that reform and improvement of the mental health services in general.