LITERATURE
ABSTRACTS
Problems in Treating the Lower Class Psychotic. David A. Carlson, Jules V. Coleman, Paul Errara and Robert W. Harrison. Archives of General Psychiatry. 1965, 13, 269-274. Some
disturbances of function. The application of a standard method for evaluating children with behavior deviations is demonstrated. Observations in this paper are limited to the relationship between behavior and adjustment as a step toward later analysis of other modalities contributing to psychiatric disorder. The information is based on mothers' reports about 482 children comprising a representative, nonpsychiatric population sample. The relative risk of maladjustment with increasing numbers of deviant behaviors is also seen to rise with the progressive constriction of the proportion of children defined as deviant. Comment is made on the limitations of analysis based on the small size of the present sample. The desirability of testing and validating the present findings in a larger group of children is emphasized.
of the problems encountered in outpatient psychiatric treatment of severely disturbed lower class patients are described, interaction of patients discharged from a state hospital with the staff of a university community psychiatric clinic is examined in an attempt to understand the apparent reluctance of patients and psychiatrists to work together. The aim of the project was to bring about coordination of care for patients and their families. Their special needs and ways of relating were described. The major problem in providing care to these patients revolved around the ditficulties the residents had in reconciling an indicated directive treatment approach with the values implicit in expressive psychotherapy. Suicide and the Hospital Service. Kingsley Jones. British Journal o/ Psychiatry, 1965, 111, 625-630. Thirty cases of suicide in one English town within a seven-year period were studied retrospectively. The proportions of physical and mental illness were higher than in a control group matched for age and sex. Attention is drawn to the necessity for active follow-up of discharged psychiatric patients and the possible need for psychiatric intervention in prolonged physical illness.
Social Class and Psychiatric Disorders: A T e n Year Follow.Up. Jerome K. Mayers, Lee L. Bean and Max P. Pepper. Journal o/ Health and Human Behavior. 1965, 6, 74-79. This article is a report on part of an extensive follow-up study of persons enumerated in the 1950 New Haven Psychiatric Census. The findings supported the hypothesis that there is a significant relationship between social class and patients' treatment status at follow-up in 1960. As social class of patients becomes higher, the proportion not under hospital care increases. The follow-up status of patients in hospital and outpatient clinic treatment in 1950 differed significantly. However in both groups the same pattern of class differences were found: the lower the social class position, the greater the proportion under hospital care in 1960 or at the time of their death. Among patients living in the community the opposite relationship was found between social class and psychiatric treatment: the lower the social class, the smaller the proportion of patients in outpatient care, either in clinics or private practice.
A Comprehensive Department of Psychological Medicine: The Problem of the DayPatient Case-Load: A 12-Month's Review. Manrice Silverman. The International Journal of Social Psychiatry, 1965, 11, 204-209. The setting in which day-patients are treated in a comprehensive psychiatric department is described. An analysis is made of the day-patient case-load for 12 months ending on January 14, 1963. The significance of the findings is discussed. It is concluded that in a comprehensive psychiatric department of a general hospital, if the patient cooperated satisfactorily in the day-patient regime, day care played a positive part in supporting him in the community thereby preventing his admission to a hospital or (if the illness was not of too long a standing) reducing the frequency with which he was admitted. T h e R e l a t i o n s h i p of Behavior to Adjust-
ment in a Representative Sample of Children. Rema Lapouse. American Journal o/ Public Health. 1965, 55, 1130-1141. This paper is addressed to the problem of early detection of psychiatric abnormalities in school-age children. Variability in current diagnostic criteria does not reliably permit early case-finding of psychiatrically significant behavior deviations. A definition of abnormal behavior is proposed based on the coexistence of deviant behavior, maladjustment, and
A Follow-up Study of Some Schizophrenic Patients. J. T. Leyberg. British Journal of Psychiatry. 1965, 111, 617-624. This study of a cohort of the schizophrenic patients admitted during 1960 to the psychiatric unit of a general hospital serving a district in the Manchester regio , attempted to follow-up these patients three years after their admission--regarding length of hospital stay, resettlement in the community, their acceptance by their families and community, their employment record, and the ett~ciency of the existing service, and its usefulness in preventing readmission. This study encdurages the belief that an accessible and integrated service with its emphasis on speedy treatment, continuity of aftercare and day-hospital facilities, is likely to make a positive contribution to the management of schizophrenic patients in the community.
97
98
T E E COMMUNITY MENTAL HEALTE JOURNAL
The Psychiatric Nurse in a Mental Health Clinic. Ken Lessler and Jeanne Bridges. Mental Hygiene, 1965, 49, 324-330. A 14-month demonstration project to explore the contribution a psychiatric nurse might make to a community mental health clinic was established in April 1963 in a new clinic in Sanford, N.C. Liaison was initiated with public health nurses and welfare workers, the local public school system, and other community agencies. The nurse also participated in consuhive treatment and diagnostic services in the clinic. Certain recommendations were made for the use of a psychiatric nurse in such a setting: that she could furnish an extension of services of other professional staff in the clinic and the community and act as coordinator for the clinic with various community groups and individuals. For the psychiatric nurse an emotional and intellectual reorientation from the adjunctive therapeutic relationship with patients to the community model of helping was necessary. U.S. Mental Hospital Population Trends. Kurt Gorwitz. Canada's Mental Health, 1965, 3, 17-23. The author reviews and interprets the trends since W.W. II of the patient population
in United States mental hospitals with specific reference to the Maryland psychiatric case register project. A case is made for differentiating qualitative and quantitative goals and reaffirming basic aims to reduce hospital populations through coordinated programs involving all potential resources and offering the best possible services to the mentally ill. The Role of a Day Hospital in Geriatric Psychiatry. W. M. Ford Robertson and Briee Pitt. British Journal o/Psychiatry, 1965, 111, 635640.--~This is a report of 3 years' work in a large, well-equipped psychogeriatric day hospital, St. Clement's, in the East End of London. It was concluded that day hospitals have an important place in the expanding field of geriatric psychiatry. The advantage of the setting within a psychiatric hospital situated in the area it serves and the mutual benefits derived from close association with a psycbogeriatric ward are emphasized. The value in affording prompt relief of crises in the community until admission to hospital can be arranged, in maintaining demented and other chronic patients, and in giving respite to relatives is explained.
Statement of ownersliip, management and circulation (act of October 23, 1962: Section 4369, Title 39, United States Code). 1. Date o f Filing, 10-1-65. 2. Title of Publication, Community Mental Health Journal. 3. Frequency of Issue, Quarterly. 4. Location of known ot~ice of publication, P.O. Box 23, Lexington, Massachusetts 02173. Location of the headquarters or general business offices of the publishers, 7 Oakland St., Lexington, Massachusetts 02173. 6. Names and addresses of publisher, editor, and managing editor. Publisher, Behavioral Publications, Inc., P.O. Box 23, ,Lexington, Mass. 02173. Editor, Sheldon R. Roen, Ph.D., South Shore Mental Health Center, 12 Dimmock St., Quincy, Massachusetts 02169. Managing editor, none. 7. Owner (If owned by a corporation, its name and address must be stated and also immediately thereunder the names and addresses of stockholders owning or holding 1 percent or more of total amount of stock. If not owned by a corporation, the names and addresses of the individual owners must be given. If owned by a partnership or other unincorporated firm, its name and address, as well as that of each individual must be given.) Behavioral Publications, Inc., P.O. Box 23, Lexington, Mass. 02173. Sheldon R. Roen, Ph.D., 12 Dimmock St., Quincy, Mass. 02169. 8. Known bondholders, mortgagees, and other security holders owning or holding 1 percent or more of total amount of bonds, mortgages or other securities (If there are none, so state) None. 9. Paragraphs 7 and 8 include, in cases where the stockholder or security holder appears upon the books of the company as trustee or in any other fiduciary relation, the name of the person or corporation for whom such trustee is acting, also the statements in the two paragraphs show the a f a n t ' s full knowledge and belief as to the circumstances and conditions under which stockholders and security holders who do
not appear upon the books of the company as trustees, hold stock and securities in a capacity other than that of a bona fide owner. Names and addresses of individuals who are stockholders of a corporation which itself is a stockholder or holder of bonds, mortgages or other securities of the publishing corporation have been included in paragraphs 7 and 8 when the interests of such individuals are equivalent to 1 percent or more of the total amount of the stock or securities of the publishing corporation. 10. This item must be completed for all publications except those which do not carry advertising other than the publisher's own and which are named in sections 132.231, 132.232, and 132.233, postal manual (Sections 4355a, 4355b, and 4356, of Title 39, United States Code). Average No. copies each issue during preceding 12 months: A. total no. copies printed (Net Press Run), 3,700; B. paid circulation; 1. sales through dealers and carriers, street vendors and counter sales, none; 2. mail subscriptions, 2,500; C. total paid circulation, 2,500; D. free distribution (including samples) by mail, carrier or other means, 70; E. total distribution (Sum of C and D), 2,570; F. o f c e use, left-over, unaccounted, spoiled after printing, 1,130; G. total (Sum of E & F--should equal net press run shown in A) 3,700. Single issue nearest to filing date. A. total no. copies printed (Net Press Run). 4,500; B. paid circulation; 1. sales through dealers and carriers, street vendors and counter sales, None; 2. mail subscriptions, 3,500; C. total paid circulation, 3,500; D. free distribution (including samples) by mail, carrier or other means, 87; E. total distribution (Sum of C and D), 3,587; F. office use, left-over, unaccounted, spoiled after printing, 913; G. total (Sum of E & F--should equal net press run shown in A) 4,500. I certify that the statements made by me above are correct and complete. Sheldon R. Roen, Editor.
LITERATURE ABSTRACTS
Human Relations Training for Psychiatric Patients: A Follow-up Study. Dale L. Johnson, Philip G. Hanson, Paul Rothaus, Robert B. Morton, Francis A. Lyle and Raymond Meyer. The International Journal o/ Social Psychiatry, 1965, 11, 188-195. The effectiveness of a new approach to changing the attitudes and behavior of the psychiatric patient the Human Relations Training Laboratory--was evaluated by comparing its follow-up results with those of a more conventional therapy program. Both treatment programs were located in the same VA hospital and drew patients from the same sources. A mailed questionnaire study was conducted for nine months following participation in the program. This yielded results from 114 patients attending the training laboratory (PTL) and 76 group therapy (GT) patients. The following significant differences were obtained: the PTL had more men employed at the time of the follow-up, a longer mean length of employment, fewer days in the treatment program, and a greater tendency to construe personal change in interpersonal terms. The GT patients reported fewer physical symptoms. The groups did not differ in rehospitalization, psychological well-being, drinking problems, or social participation. The overall results were interpreted as indicating distinct advantages for the PTL approach, especially in that it produced results at least as good as the GT program--and restored more men to productive employment-with shorter hospitalization and smaller staffing requirements.
A Teaching Program in Publie Health Psychiatry. Jules V. Coleman, Claudewell S. Thomas, and Bernard J. Bergen. American Journal of Psychiatry, 1965, 122, 285.289. The authors discussed the Yale teaching program in public health psychiatry from the point of view of a number of relevant issues in community practice and research. Three areas are stressed: unmet psychiatric need, particularly in the lowest socioeconomic class; paths to treatment; and the area of community organization. The W o r k of a Psychiatric Emergency Clinic. John Brothwood. British Journal el Psychiatry. 1965, 111, 631-634. A study conducted to evaluate the functions which Maudsley Hospital Emergency Clinic is performi,Jg and to briefly compare patients attending the Clinic with outpatients at the Hospital and patients in an observation ward. It was concluded that the majority of patients attending the Emergency Clinic do not differ significantly in diagnostic groups nor behavior from outpatients. It was suggested that the most useful functions of the clinic are the assessment of the need for admission or other urgent treatment, the correct allocation of patients to available services, and the prompt assumption of clinical responsibility for the patient. Attention was drawn to a group of patients who fail to consult their family doctor and refer themselves spontaneously to the clinic instead.
99
MICHIGAN DEPARTMENT OF MENTAL HEALTH The rapid growth of Michigan's mental health program has created m a n y excellent opportunities for professionals in all disciplines. The advances that have been made and the steps that are yet to be taken combine to make these positions both personally satisfying and professionally challenging. Openings exist in most of the major metropolitan and suburban centers as well as in a few of the resort and vacation areas. The salaries offered are quite competitive and the fringe benefits provided under Michigan's Civil Service are exceptional. F o r further information contact: IVAN E. ESTES, PERSONNEL DIRECTOR MICHIGAN DEPARTMENT OF MENTAL HEALTH Room 530 M LEWIS CASS BUILDING LANSING, MICmGAN 4 8 9 1 3
An Equal Opportunity Employer
S o m e P r i n c i p l e s of D y n a m i c Psychiatry in Relation to Poverty. Viola W. Bernard. American Journal o/ Psychiatry, 1965, 122, 254-267. A general treatment of the relation between poverty and mental illness and strategies of intervention with economically deprived mentally ill persons. The case is made that class IV and V patients can be reached but that new, more flexible modes of approach must be pursued. One case study out of the author's experience is discussed at some length.
The Therapeutic Communlty--Concept, Practice and Future. D. H. Clark. British Journal el Psychiatry, 1965, 111, 947-954. The concept of the therapeutic community has emerged in the last 20 years in British and American psychiatry. Its history and related definitions are discussed. The therapeutic community approach of open doors, full activity, increased freedom and responsibility for patients has had widespread effects throughout British institutional psychiatry. The therapeutic community proper, a small, faceto-face intensive treatment organization with social restructuring and role blurring for staff and patients has been less widely accepted. The Mental Health Research Fund has supported work and research at Fulbourn Hospital in both areas; some of the results are described and future developments are discussed.
ABSTRACTS
Problems in Treating the Lower Class Psychotic. David A. Carlson, Jules V. Coleman, Paul Errara and Robert W. Harrison. Archives of General Psychiatry. 1965, 13, 269-274. Some
disturbances of function. The application of a standard method for evaluating children with behavior deviations is demonstrated. Observations in this paper are limited to the relationship between behavior and adjustment as a step toward later analysis of other modalities contributing to psychiatric disorder. The information is based on mothers' reports about 482 children comprising a representative, nonpsychiatric population sample. The relative risk of maladjustment with increasing numbers of deviant behaviors is also seen to rise with the progressive constriction of the proportion of children defined as deviant. Comment is made on the limitations of analysis based on the small size of the present sample. The desirability of testing and validating the present findings in a larger group of children is emphasized.
of the problems encountered in outpatient psychiatric treatment of severely disturbed lower class patients are described, interaction of patients discharged from a state hospital with the staff of a university community psychiatric clinic is examined in an attempt to understand the apparent reluctance of patients and psychiatrists to work together. The aim of the project was to bring about coordination of care for patients and their families. Their special needs and ways of relating were described. The major problem in providing care to these patients revolved around the ditficulties the residents had in reconciling an indicated directive treatment approach with the values implicit in expressive psychotherapy. Suicide and the Hospital Service. Kingsley Jones. British Journal o/ Psychiatry, 1965, 111, 625-630. Thirty cases of suicide in one English town within a seven-year period were studied retrospectively. The proportions of physical and mental illness were higher than in a control group matched for age and sex. Attention is drawn to the necessity for active follow-up of discharged psychiatric patients and the possible need for psychiatric intervention in prolonged physical illness.
Social Class and Psychiatric Disorders: A T e n Year Follow.Up. Jerome K. Mayers, Lee L. Bean and Max P. Pepper. Journal o/ Health and Human Behavior. 1965, 6, 74-79. This article is a report on part of an extensive follow-up study of persons enumerated in the 1950 New Haven Psychiatric Census. The findings supported the hypothesis that there is a significant relationship between social class and patients' treatment status at follow-up in 1960. As social class of patients becomes higher, the proportion not under hospital care increases. The follow-up status of patients in hospital and outpatient clinic treatment in 1950 differed significantly. However in both groups the same pattern of class differences were found: the lower the social class position, the greater the proportion under hospital care in 1960 or at the time of their death. Among patients living in the community the opposite relationship was found between social class and psychiatric treatment: the lower the social class, the smaller the proportion of patients in outpatient care, either in clinics or private practice.
A Comprehensive Department of Psychological Medicine: The Problem of the DayPatient Case-Load: A 12-Month's Review. Manrice Silverman. The International Journal of Social Psychiatry, 1965, 11, 204-209. The setting in which day-patients are treated in a comprehensive psychiatric department is described. An analysis is made of the day-patient case-load for 12 months ending on January 14, 1963. The significance of the findings is discussed. It is concluded that in a comprehensive psychiatric department of a general hospital, if the patient cooperated satisfactorily in the day-patient regime, day care played a positive part in supporting him in the community thereby preventing his admission to a hospital or (if the illness was not of too long a standing) reducing the frequency with which he was admitted. T h e R e l a t i o n s h i p of Behavior to Adjust-
ment in a Representative Sample of Children. Rema Lapouse. American Journal o/ Public Health. 1965, 55, 1130-1141. This paper is addressed to the problem of early detection of psychiatric abnormalities in school-age children. Variability in current diagnostic criteria does not reliably permit early case-finding of psychiatrically significant behavior deviations. A definition of abnormal behavior is proposed based on the coexistence of deviant behavior, maladjustment, and
A Follow-up Study of Some Schizophrenic Patients. J. T. Leyberg. British Journal of Psychiatry. 1965, 111, 617-624. This study of a cohort of the schizophrenic patients admitted during 1960 to the psychiatric unit of a general hospital serving a district in the Manchester regio , attempted to follow-up these patients three years after their admission--regarding length of hospital stay, resettlement in the community, their acceptance by their families and community, their employment record, and the ett~ciency of the existing service, and its usefulness in preventing readmission. This study encdurages the belief that an accessible and integrated service with its emphasis on speedy treatment, continuity of aftercare and day-hospital facilities, is likely to make a positive contribution to the management of schizophrenic patients in the community.
97
98
T E E COMMUNITY MENTAL HEALTE JOURNAL
The Psychiatric Nurse in a Mental Health Clinic. Ken Lessler and Jeanne Bridges. Mental Hygiene, 1965, 49, 324-330. A 14-month demonstration project to explore the contribution a psychiatric nurse might make to a community mental health clinic was established in April 1963 in a new clinic in Sanford, N.C. Liaison was initiated with public health nurses and welfare workers, the local public school system, and other community agencies. The nurse also participated in consuhive treatment and diagnostic services in the clinic. Certain recommendations were made for the use of a psychiatric nurse in such a setting: that she could furnish an extension of services of other professional staff in the clinic and the community and act as coordinator for the clinic with various community groups and individuals. For the psychiatric nurse an emotional and intellectual reorientation from the adjunctive therapeutic relationship with patients to the community model of helping was necessary. U.S. Mental Hospital Population Trends. Kurt Gorwitz. Canada's Mental Health, 1965, 3, 17-23. The author reviews and interprets the trends since W.W. II of the patient population
in United States mental hospitals with specific reference to the Maryland psychiatric case register project. A case is made for differentiating qualitative and quantitative goals and reaffirming basic aims to reduce hospital populations through coordinated programs involving all potential resources and offering the best possible services to the mentally ill. The Role of a Day Hospital in Geriatric Psychiatry. W. M. Ford Robertson and Briee Pitt. British Journal o/Psychiatry, 1965, 111, 635640.--~This is a report of 3 years' work in a large, well-equipped psychogeriatric day hospital, St. Clement's, in the East End of London. It was concluded that day hospitals have an important place in the expanding field of geriatric psychiatry. The advantage of the setting within a psychiatric hospital situated in the area it serves and the mutual benefits derived from close association with a psycbogeriatric ward are emphasized. The value in affording prompt relief of crises in the community until admission to hospital can be arranged, in maintaining demented and other chronic patients, and in giving respite to relatives is explained.
Statement of ownersliip, management and circulation (act of October 23, 1962: Section 4369, Title 39, United States Code). 1. Date o f Filing, 10-1-65. 2. Title of Publication, Community Mental Health Journal. 3. Frequency of Issue, Quarterly. 4. Location of known ot~ice of publication, P.O. Box 23, Lexington, Massachusetts 02173. Location of the headquarters or general business offices of the publishers, 7 Oakland St., Lexington, Massachusetts 02173. 6. Names and addresses of publisher, editor, and managing editor. Publisher, Behavioral Publications, Inc., P.O. Box 23, ,Lexington, Mass. 02173. Editor, Sheldon R. Roen, Ph.D., South Shore Mental Health Center, 12 Dimmock St., Quincy, Massachusetts 02169. Managing editor, none. 7. Owner (If owned by a corporation, its name and address must be stated and also immediately thereunder the names and addresses of stockholders owning or holding 1 percent or more of total amount of stock. If not owned by a corporation, the names and addresses of the individual owners must be given. If owned by a partnership or other unincorporated firm, its name and address, as well as that of each individual must be given.) Behavioral Publications, Inc., P.O. Box 23, Lexington, Mass. 02173. Sheldon R. Roen, Ph.D., 12 Dimmock St., Quincy, Mass. 02169. 8. Known bondholders, mortgagees, and other security holders owning or holding 1 percent or more of total amount of bonds, mortgages or other securities (If there are none, so state) None. 9. Paragraphs 7 and 8 include, in cases where the stockholder or security holder appears upon the books of the company as trustee or in any other fiduciary relation, the name of the person or corporation for whom such trustee is acting, also the statements in the two paragraphs show the a f a n t ' s full knowledge and belief as to the circumstances and conditions under which stockholders and security holders who do
not appear upon the books of the company as trustees, hold stock and securities in a capacity other than that of a bona fide owner. Names and addresses of individuals who are stockholders of a corporation which itself is a stockholder or holder of bonds, mortgages or other securities of the publishing corporation have been included in paragraphs 7 and 8 when the interests of such individuals are equivalent to 1 percent or more of the total amount of the stock or securities of the publishing corporation. 10. This item must be completed for all publications except those which do not carry advertising other than the publisher's own and which are named in sections 132.231, 132.232, and 132.233, postal manual (Sections 4355a, 4355b, and 4356, of Title 39, United States Code). Average No. copies each issue during preceding 12 months: A. total no. copies printed (Net Press Run), 3,700; B. paid circulation; 1. sales through dealers and carriers, street vendors and counter sales, none; 2. mail subscriptions, 2,500; C. total paid circulation, 2,500; D. free distribution (including samples) by mail, carrier or other means, 70; E. total distribution (Sum of C and D), 2,570; F. o f c e use, left-over, unaccounted, spoiled after printing, 1,130; G. total (Sum of E & F--should equal net press run shown in A) 3,700. Single issue nearest to filing date. A. total no. copies printed (Net Press Run). 4,500; B. paid circulation; 1. sales through dealers and carriers, street vendors and counter sales, None; 2. mail subscriptions, 3,500; C. total paid circulation, 3,500; D. free distribution (including samples) by mail, carrier or other means, 87; E. total distribution (Sum of C and D), 3,587; F. office use, left-over, unaccounted, spoiled after printing, 913; G. total (Sum of E & F--should equal net press run shown in A) 4,500. I certify that the statements made by me above are correct and complete. Sheldon R. Roen, Editor.
LITERATURE ABSTRACTS
Human Relations Training for Psychiatric Patients: A Follow-up Study. Dale L. Johnson, Philip G. Hanson, Paul Rothaus, Robert B. Morton, Francis A. Lyle and Raymond Meyer. The International Journal o/ Social Psychiatry, 1965, 11, 188-195. The effectiveness of a new approach to changing the attitudes and behavior of the psychiatric patient the Human Relations Training Laboratory--was evaluated by comparing its follow-up results with those of a more conventional therapy program. Both treatment programs were located in the same VA hospital and drew patients from the same sources. A mailed questionnaire study was conducted for nine months following participation in the program. This yielded results from 114 patients attending the training laboratory (PTL) and 76 group therapy (GT) patients. The following significant differences were obtained: the PTL had more men employed at the time of the follow-up, a longer mean length of employment, fewer days in the treatment program, and a greater tendency to construe personal change in interpersonal terms. The GT patients reported fewer physical symptoms. The groups did not differ in rehospitalization, psychological well-being, drinking problems, or social participation. The overall results were interpreted as indicating distinct advantages for the PTL approach, especially in that it produced results at least as good as the GT program--and restored more men to productive employment-with shorter hospitalization and smaller staffing requirements.
A Teaching Program in Publie Health Psychiatry. Jules V. Coleman, Claudewell S. Thomas, and Bernard J. Bergen. American Journal of Psychiatry, 1965, 122, 285.289. The authors discussed the Yale teaching program in public health psychiatry from the point of view of a number of relevant issues in community practice and research. Three areas are stressed: unmet psychiatric need, particularly in the lowest socioeconomic class; paths to treatment; and the area of community organization. The W o r k of a Psychiatric Emergency Clinic. John Brothwood. British Journal el Psychiatry. 1965, 111, 631-634. A study conducted to evaluate the functions which Maudsley Hospital Emergency Clinic is performi,Jg and to briefly compare patients attending the Clinic with outpatients at the Hospital and patients in an observation ward. It was concluded that the majority of patients attending the Emergency Clinic do not differ significantly in diagnostic groups nor behavior from outpatients. It was suggested that the most useful functions of the clinic are the assessment of the need for admission or other urgent treatment, the correct allocation of patients to available services, and the prompt assumption of clinical responsibility for the patient. Attention was drawn to a group of patients who fail to consult their family doctor and refer themselves spontaneously to the clinic instead.
99
MICHIGAN DEPARTMENT OF MENTAL HEALTH The rapid growth of Michigan's mental health program has created m a n y excellent opportunities for professionals in all disciplines. The advances that have been made and the steps that are yet to be taken combine to make these positions both personally satisfying and professionally challenging. Openings exist in most of the major metropolitan and suburban centers as well as in a few of the resort and vacation areas. The salaries offered are quite competitive and the fringe benefits provided under Michigan's Civil Service are exceptional. F o r further information contact: IVAN E. ESTES, PERSONNEL DIRECTOR MICHIGAN DEPARTMENT OF MENTAL HEALTH Room 530 M LEWIS CASS BUILDING LANSING, MICmGAN 4 8 9 1 3
An Equal Opportunity Employer
S o m e P r i n c i p l e s of D y n a m i c Psychiatry in Relation to Poverty. Viola W. Bernard. American Journal o/ Psychiatry, 1965, 122, 254-267. A general treatment of the relation between poverty and mental illness and strategies of intervention with economically deprived mentally ill persons. The case is made that class IV and V patients can be reached but that new, more flexible modes of approach must be pursued. One case study out of the author's experience is discussed at some length.
The Therapeutic Communlty--Concept, Practice and Future. D. H. Clark. British Journal el Psychiatry, 1965, 111, 947-954. The concept of the therapeutic community has emerged in the last 20 years in British and American psychiatry. Its history and related definitions are discussed. The therapeutic community approach of open doors, full activity, increased freedom and responsibility for patients has had widespread effects throughout British institutional psychiatry. The therapeutic community proper, a small, faceto-face intensive treatment organization with social restructuring and role blurring for staff and patients has been less widely accepted. The Mental Health Research Fund has supported work and research at Fulbourn Hospital in both areas; some of the results are described and future developments are discussed.
