The return of the patient to the community is the goal of institutional treatment programs for mentally ill persons. The attention and effort made in recent years toward improved care of mental patients in hospital has also included consideration of the material and emotional needs of the patient at the point of leaving the hospital. This study examines the discharge situations of male patients treated at the Crease Clinic of Psychological Medicine at Essondale; and describes the role of social workers in patients’ re-establishment in the community. The needs and problems revealed by the study are examined in the perspective of a comprehensive rehabilitation service for discharged mental patients. The method used in the study was to compile pertinent information from the case records of 100 male patients discharged in a recent year. The information was extracted from the case records by means of a schedule. From this information was tabulated some of the common needs of patients leaving Crease Clinic. An analysis was then made of resources within the Clinic and in the community at large whereby the recorded needs might be met. A selection of case summaries was made to illustrate some typical problems. The factual material illustrated the variety and frequency of rehabilitation needs. For the mental patient these included not only material needs for housing and a job, but also intangible needs for support and help with continuing emotional stress. The interrelationship of outer material needs and inner emotional problems was noted. It was found that needs for housing and a job were a problem for approximately one patient in five; and that the proportion of patients who required help with inner stresses was approximately one in three. An examination of the resources available for meeting needs revealed significant gaps and limitations in the provision of subsidized boarding care and in the financing of vocational training. An over-all deficiency was apparent in the numbers of professionally trained social workers. In the concluding chapter there is suggested an operational definition of rehabilitation: a process whereby needs are met which enable the patient to become re-established as a citizen. There is a discussion of ways and means of narrowing the gap between needs and resources, and of the role of the social worker in community action. The development of social welfare resources for discharged mental patients is related to a network of community facilities concerned both with civilian rehabilitation and with mental health maintenance. / Arts, Faculty of / Social Work, School of / Graduate

There has been a growing trend to discharge patients from mental hospitals after short periods of hospitalization. These discharged patients may have unresolved problems and need continuing service in the community if they are to maintain their level of social functioning. The After Care Clinic in Burnaby was formed to provide continuing service to the patient. However there is much concern about the high readmission rates to the hospital and the adequacy of the aftercare services. The present study is a pilot study to examine the services provided by the After Care Clinic. The researchers reviewed aftercare literature and utilized hospital records. Information was obtained from questionnaires to patients, clinic staff and other agency staff. Prom these sources the social, work, and home needs of patients and the treatment given were examined. Opinions about the aftercare services and possible improvements were also examined in an attempt to assess the adequacy of the services provided by the After Care Clinic. The findings showed a large number of patient needs and nominal service given. Treatment was medically oriented with brief supportive therapy. Only one person in the sample of 45 saw a social worker. The staff of the clinic and other agencies were aware of the lack of services for the discharged patient but differed in their perception of their roles and their expectations of an adequate service. The clinic staff thought that responsibility for aftercare services should be shared between hospital and community agencies. However community agencies felt that the hospital should assume responsibility. These findings indicate the present gaps in the aftercare services and the need, for responsibility and leadership. It seemed, apparent that it should be the role of the mental health branch to take responsibility for leadership in the development of a coordinated and comprehensive aftercare service. / Arts, Faculty of / Social Work, School of / Graduate

No description available.

No description available.

This study was designed to assess the community identification of discharged mental patients in community boarding homes-specifically, those patients discharged from the Riverview Mental Hospital and placed directly into Vancouver City boarding homes as part of a cooperative programme between the Social Service Department of the Riverview Hospital and the Medical Section of the City Social Service Department. Community identification was defined in terms of three factors: physical presence in a geographic area; quality and quantity of social participation; and, relative opportunity for decision-making and independent functioning. Quantitative measurement of the latter two factors was attained through administering the Chapin Leisure Participation and Enjoyment Scale and the Vine-land Social Maturity Scale respectively. A qualitative measurement was attained by administering two questionnaires designed by the researchers--one to the boarding home operators, the other to the patients in the boarding homes The design of the study was initially that of a retrospective nature, comparing current data to data of previous performance obtained from hospital files. As this latter source proved inadequate, a longitudinal design was proposed, and a pretest of the research instruments was implemented with a boarding home sample and a comparative hospital sample. The findings of the study thus pertain to the qualitative responses of the former patients in community boarding homes, and to qualitative comparisons of the responses of the community and hospital samples. The qualitative responses were generally of a positive nature indicating a satisfaction with community placement and an enjoyment of community life. The quantitative responses indicated a decrease of social participation, occupational activity and socialization skills following placement into the community boarding homes, but an increase in the skill of self-direction and competency of locomotion. A comparison of the interviewers' ratings and the patients' ratings of significant impediments to social functioning indicated that the latter perceived this in financial terms while the former perceived it in psychological terms. Conclusions of this study, necessarily limited because of its preliminary nature, relate primarily to the concept of community identification and to the difficulty of defining this concept in concrete terms. As the findings indicated that autonomy and independent decision-making were most closely related to subjective feelings of community identity, and that this increase in autonomy was related to increased feelings of dignity and self-worth, it was suggested that greater autonomy was the principal factor in the community identification of this population, and that this indicated a positive evaluation of the boarding home placement programme in that it led to the enhancement of the patients' feelings of dignity and self-worth. Recommendations for improvement of the programme include psychiatrically trained staff to supervise the patients, new regulations concerning finances, and provision of more activities and facilities designed to enhance the patients' feelings of self-worth. / Arts, Faculty of / Social Work, School of / Graduate

Individuals with a psychiatric disability have had the poorest vocational outcomes of all the disabled populations when comparing rehabilitation success rates. The purpose of this study was to explore the relationships between selected background, social, and service variables and vocational rehabilitation outcome in order to identify potential indicators of success or failure. Data was gathered from records in the Tucson, Arizona offices of the state-federal vocational rehabilitation program. The sample included 210 White and Hispanic subjects with a psychiatric disability. Their records had been closed in the years 1983 through 1987. The independent variables were the background variables of Age, Age of Onset, Ethnicity, and Educational Level, the social variables of Living Situation, Ability To Get Along With Others, and Employment History, and the service variables of Training and Support. The dependent variable was Employment Status as determined by the vocational rehabilitation program: Successful subjects, coded a Status 26, were closed having been employed at least 60 days; unsuccessful subjects, coded a Status 08, 28, or 30, left the program unemployed. The study followed a correlational design using a regression approach. Logistic Regression Analysis with forward selection was the strategy employed to identify the best predictive model. A chi-square test of independence was used to further study variables that showed some predictive potential. An effort was made to control for the presence of one or more additional disabilities. The results indicated that the variables most highly related to Employment Outcome, in the order of their importance, were Training, Employment History, and Ability To Get Along With Others. Ability To Get Along With Others disappeared as a key indicator when the sample was divided into single and multiple disability groups. However, the findings suggest that Ability To Get Along With Others and Support Services may contribute to the effect of the two more powerful variables. It is also cautiously suggested that Training that is job-related and skill-building in nature may be more useful than formal education for this population.

Research in community management of the severely mentally ill has been scarce. Two primary components of community care in particular need evaluation, residential arrangements and styles of "case management." The purpose of this study was to evaluate the interaction of two types of residential arrangements (single- and double-occupancy) and two types of case management ("assertive" and "limited") in a 2 X 2 design. Participants were individuals with a severe mental illness served by CMHS, Inc. Individuals were matched on DSM-III-R diagnoses and sex: 8 had roommates and received assertive case management, 5 had roommates and limited case management, 5 lived alone and received assertive case management, and 5 lived alone with limited case management. Data were obtained from three independent sources: (1) each client was interviewed using the Denver Community Mental Health Questionnaire (DCMHQ) and the Inventory of Socially Supportive Behaviors (ISSB) on four separate occasions over three consecutive months; (2) frequency of client contact with family members over the same time interval was tracked by case managers; and (3) concurrent attendance in day treatment sessions, diagnosis, number of previous hospitalizations, and approximate number of months of previous hospitalization were obtained from community mental health center records. DCMHQ scores for acute symptoms and interpersonal conflict were combined into an index called problems, while ISSB scores measured social support received. Monthly follow-ups for three consecutive months were used to obtain stable estimates of problems and support. Significant positive correlations were found between family involvement and problems, family involvement and residential arrangements, social support and problems, group attendance percentage and age, problems and social support, and a marginal relationship between residence and social support. Statistically significant negative correlations were found between case management and problems, social support and number of previous hospitalizations, group attendance percentage and problems, and residence and age. In multiple regression involving all predictors, the variables other than roommating and case management, (i.e., average family involvement, number of previous hospitalizations, program attendance, and age, considered together) predicted both problems reported and support received, while as second and third steps in the regression analysis case management and residence did not significantly predict problems or social support. In other words, once chronicity (i.e., number of previous hospitalizations), family contact, age, and group attendance were controlled, case management and residence both vanished as predictors. Future studies should consider these factors, and other aspects of the natural context, when evaluating community interventions for the mentally ill in a more controlled experimental design. With respect to developing new research for community adjustment, recommendations for more controlled studies were made and two new community intervention procedures were described. / Department of Psychological Science

published_or_final_version / Public Administration / Master / Master of Public Administration

published_or_final_version / Social Work / Master / Master of Social Sciences

published_or_final_version / Social Work / Master / Master of Social Work