The Sustaining Clinic is a recently-added service provided by the Mental Health Centre in British Columbia for a selected group of patients who are unable, for a variety of reasons, to benefit from more intensive therapy than a monthly interview. This study reviews the contribution of the therapeutic team at the Sustaining Clinic (of which the social worker is a part), toward the rehabilitation of a difficult group of mentally-ill patients, most of whom require long-term follow-up care. To emphasize the focus on the appropriate type of patients, the method is to review (1) the problems of a sample group of these patients, and (2) the treatment services given to them; thus, establishing how far this meets their needs. Treatment is evaluated with the aid of three rating scales assessing the patient's functioning at the time of referral and at the time of discharge. The evidence is that (1) The enormous disability associated with these patients is to a large extent imposed, preventable, and treatable. Disability originates particularly from parental rejection, and is later magnified by the rejection mechanisms stemming from cultural attitudes. (2) The treatment provided by the Sustaining Clinic is effective because it is related to the needs of the patient and to the specific conditions surrounding his illness. Therapeutic contributions include regulation of medication, support in cases of stress, limit-setting, information-giving, manipulation of the environment, and providing a figure for identification. (3) More resources than the Clinic can provide will be needed, because of the deep-seated personal and social handicaps of these patients. This study itself can be helpful only if coordinated with others which examine other "halfway house" programs, and the social worker's participation in them. / Arts, Faculty of / Social Work, School of / Graduate

The goal of treatment is the restoration of the mental patient to the community. This study has sought to show that family care is a useful device for rehabilitation, both for the person for whom return to independent living is expected, and as a means of providing a more satisfactory way of life than the hospital environment for the person who will continue to need supervision. The method used was to survey the development of family care in Europe, Canada and the United States, and to compare various characteristics of U. S. programs in New Jersey, Wisconsin, Michigan, California, Idaho, Maryland, Kentucky and Minnesota. A report of the Veterans Administration, Washington, D. C. was examined, and a study was also made of special features of foster care programs in the Veterans Administration Hospital at Bedford, Massachusetts, and St. Cloud, Minnesota. A general assessment was made of existing arrangements for boarding home care of mental patients in British Columbia, with special reference to community resources available, in order to determine the relative merits of boarding home placement versus family care. In this connection the files of all patients placed in boarding home care by one full-time social worker at the Provincial Mental Hospital, Essondale, B. C., between July 1, 1959 and August 31, 1960 (comprising 20 patients in all) were closely examined to establish the main characteristics of the group and their community adjustment. In the concluding chapter, as a result of the various comparisons made, it was possible to draw up a check list of criteria which could serve as a guide in setting up and developing future family care programs. The check list in summary comprises the following points: (1) orientation of hospital employees and the community to the program; (2) preparation of the patient; (3) sufficient number of social workers to operate the program; (4) sponsors suited to the task of caring for patients; (5) adequate physical standards in the home; (6) provision of medical services for patients; (7) provision of clothing and money for incidental expenses and comforts allowance for patients without means; (8) encouragement of appropriate social activities; (9) homes of varying sizes to meet the needs of different patients; (10) location of the home within access of community facilities for the benefit of patients. The broad conclusion is that the provision of adequate services will ultimately depend on the assumption by the community of the responsibility for the rehabilitation of the mentally ill. / Arts, Faculty of / Social Work, School of / Graduate