Treating People With Psychosis In Institutions

This book focuses on the priority that psychoanalysis places on the individual, how the treatment is conceived theoretically and the ways it can be incorporated in the overall organisation of an institution. It brings together the histories of a number of psychoanalytically informed hospitals.

This manual attempts to provide simple, adequate and evidence-based information to health care professionals in primary health care especially in low- and middle-income countries to be able to provide pharmacological treatment to persons with mental disorders. The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalized anxiety and sleep disorders; obsessive compulsive disorders and panic attacks; and alcohol and opioid dependence. The annexes provide information on evidence retrieval, assessment and synthesis and the peer view process.

Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Discover an alternative realm of psychiatry—without offices or couches! The Casebook of a Residential Care Psychiatrist: Psychopharmacosocioeconomics and the Treatment of Schizophrenia in Residential Care Facilities addresses the problems involved in the onsite treatment of mentally ill patients in residential care facilities. This book is the first to identify the need for psychiatrists to be available to individuals in such facilities as adult homes, community care homes, transitional living facilities, and rest homes. This vital resource also contains specific recommendations as to how these visits should be conducted with regard to frequency, duration, space, and the types of Medicare procedure codes to utilize. In The Casebook of a Residential Care Psychiatrist, Dr. Fleishman uses his 40 years of experience as a psychiatrist to show you the ins and outs of practicing psychiatry in residential facilities. The book also discusses the profound changes psychiatric drugs have produced in the social, economic, and legal arenas. Using anecdotes, personal stories, and actual documents from Dr. Fleishman’s files, this book provides you with a wealth of knowledge not found anywhere else. With this book, you’ll learn more about: time-saving interview/assessment techniques the importance of psychopharmacology in residential care and how it has changed the practice of psychiatry Dr. Fleishman’s method for appropriately creating and using progress notes and other records during treatment ways to work with other members of the residential facility professional community—including psychologists, social workers, pharmacists, and administrators—to make everyone’s job easier the best ways to control paperwork obligations the impact that federal, state, and local government agencies have had on mental health spending, services, and practitioners In The Casebook of a Residential Care Psychiatrist, you will find wisdom, knowledge, and advice along with case studies, tables and examples. While focused on psychiatry and schizophrenia, this book will be of interest to mental health workers, long-term caregivers, and residential facility administrators as well as psychiatrists and psychologists.

This book offers a clinical guide that brings together a broad range of brief interventions and their applications in treating psychosis. It describes two core approaches that can narrow the current, substantial gap between the need for psychotherapeutic interventions for all individuals suffering from psychosis, and the limited mental health resources available. The first approach involves utilizing the standard therapeutic modalities in the context of routine clinical interactions after adapting them into brief and effective formats. To that end, the book brings in experts on various psychotherapeutic modalities, who discuss how their particular modality could be adapted to more effectively fit into the existing system of care delivery. The second approach, addressed in detail, is to extend the availability of these brief interventions by utilizing the circle of providers as well as the social circle of the clients so that these interventions can be provided in a coordinated and complementary manner by psychiatrists, psychologists, clinical social workers, case managers, peer support specialists and other providers on the one hand, and by family members, friends, social and religious institutions on the other.

Transference in Institutional Work with Psychosis and Autism presents Pierre Delion’s extensive experience in psychiatric institutions, focusing on the concept of the transferential constellation. Delion first discusses the pioneering work of François Tosquelles at the Saint Alban psychiatric hospital, which enabled psychoanalytic treatment to be applied in cases of severe psychopathologies. The book then explains how the transferential constellation can provide a deeper and more effective understanding of a patient’s needs by engaging all caregivers within an organisation over the course of the patient’s treatment history. Delion describes how regular meetings of all the team participants allow them to express different and even divergent views of the patient and to appreciate their complementary contributions to the institution. The transferential constellation is presented as an important development in the history of patient-centered psychiatric care and a touchstone for its ongoing humanistic development. Transference in Institutional Work with Psychosis and Autism will be of great interest to psychiatrists and psychotherapists in practice and in training. It will also be key reading for other practitioners and caregivers working in mental health institutions.

Even among mental health clinicians, the communications of individuals experiencing psychosis have historically been considered mysterious, bizarre, and invalid. These judgmental, inaccurate interpretations and accusatory attitudes can cause iatrogenic trauma, a significant obstacle to recovery. Healing the Distress of Psychosis focuses on practice-based and evidence-informed interventions to effectively understand and communicate with people who are experiencing psychotic symptoms. The text thoughtfully describes: the experience of psychosis, as well as the unique intervention method of fostering the therapeutic relationship; and the psychotic thought process from neurological, linguistic, and existential-psychological perspectives. Mental health professionals, individuals with lived psychotic experiences, and their family members and loved ones will find this book to be a strong and accurate voice that highlights the past and present disappointments in mainstream public mental health treatment, while delivering hope in creating a secure, self-determined life.