tinue to have a place for the foreseeable future. Let’s concentrate on adapting and improving them, on developing a more comprehensive and flexible system of care, and on integrating state hospitals into that system of care. If we start talking in such a way, we can avoid some of the confusion that the term “deinstitutionalization” has helped create, and we can focus our attention on helping each part of the system make its maximum contribution to care of the mentally ill.
FEEDBACK TAKING “STAFF Ken
ISSUE WITH SOME BURNOUT” CONCEPTS
Meyer,
M.P.S.
.1 found the concept of staff burnout as explored by H. Richard Lamb, M.D., in the June 1979 issue (1) to be most intriguing. However, I believe his basic premise that “Services for the long-term patient have been increased
without
a sound
underlying
conceptual
frame-
work for their care” is generally invalid. To further state that most new staff who enter the field of longterm care get burned out in “a year or two” is a subjective view at best; Dr. Lamb offers no proof to support his allegation. Although I concur that mental health professionals have failed to recognize that there are many different kinds of long-term patients, I believe Dr. Lamb should indict the educational system that schooled these professionals rather than the health care system in which they are employed. And to state that “We are finally beginning [italics mine] to interest mental health professionals in the treatment and rehabilitation of longterm patients” belies the sincere and dedicated efforts that have been made over the last 15 years by true professionals in the fields of community placement and repatriation. I agree that staff must not be subjected to administrative pressure to accomplish the impossible. Perhaps the greatest threat to the delivery of sound care for longterm patients is the establishment of arbitrary and unrealistic goals for discharge planning. Furthermore, any quota system that attempts to set in advance the maximum length of stay does not take into account what Dr. Lamb clearly indicates to be the error of believing “All patients can and should be rehabilitated.” The present state of the art just does not lend credence to such a belief. I further agree that treatment staff must have a realistic view of long-term patients and the wide variations in their needs and potential. But even more, this realistic view must be present from admission-way before the patient becomes long-term. Treatment staff need to know much about the patient as an individual in order
to be aware of his needs and potential. Upon admission of the patient, staff need to obtain several kinds of information immediately: identifying information (including ethnic group, occupation, and religion), reasons for admission, data on previous hospitalizations, results of a brief mental status examination to evaluate present psychopathology, the patient’s physical condition and diagnoses for any existing medical problems, his legal status, and a provisional psychiatric diagnosis and tentative treatment plan. Of critical importance is for treatment staff to obtain a summary of anamnesis from the patient or outside informants within four weeks after admission. It will provide staff with significant findings from the patient’s psychosocial and family histories, which are good indications of his needs and potential. Perhaps I am more optimistic than Dr. Lamb about the present and future enthusiasm of those who work with long-term patients. But my optimism is in no way meant to negate the importance of being on the lookout for the possibility of staff burnout. REFERENCE 1) “Staff 396-398.
Reply
Burnout
From
in Work
H. Richard
With
Long-Term
Lamb,
854
is a business officer New York 11754.
HOSPITAL
at
Kings
Park
Psychiatric
Center, 1) Jossey-Bass,
& COMMUNITY
PSYCHIATRY
Vol.
30,
pp.
M.D.
Mr. Meyer’s thoughtful comments about my article elaborated and helped to clarify the important issues involved. Certainly most staff do not get burned out in a year or two where the goals are clear and realistic and the direction of their program is based on a sound understanding of the underlying conceptual issues. And certainly sound conceptual frameworks for the treatment and rehabilitation of long-term patients are available. For instance, the book by my associates and myself, Community Survival for Long-Term Patients, provides one such framework (1). The problem has to do with some new programs that have plunged ahead without conceptualizing both initially and on an ongoing basis what they are trying to accomplish. I also agree with Mr. Meyer that there have been sincere and dedicated efforts over the last 15 years by persons who have devoted themselves to the treatment and rehabilitation of long-term patients. The problem has been that until the past few years these programs were relatively few in number and could not begin to meet the needs of the very large population of long-term, severely disabled patients who are now living in the community. Finally, Mr. Meyer’s emphasis on obtaining detailed knowledge about each individual patient in every area of his life should be underscored for every treatment staff member working with these patients. REFERENCE
Mr. Meyer Kings Park,
Patients,”
San
Francisco,
1976.
FEEDBACK TAKING “STAFF Ken
ISSUE WITH SOME BURNOUT” CONCEPTS
Meyer,
M.P.S.
.1 found the concept of staff burnout as explored by H. Richard Lamb, M.D., in the June 1979 issue (1) to be most intriguing. However, I believe his basic premise that “Services for the long-term patient have been increased
without
a sound
underlying
conceptual
frame-
work for their care” is generally invalid. To further state that most new staff who enter the field of longterm care get burned out in “a year or two” is a subjective view at best; Dr. Lamb offers no proof to support his allegation. Although I concur that mental health professionals have failed to recognize that there are many different kinds of long-term patients, I believe Dr. Lamb should indict the educational system that schooled these professionals rather than the health care system in which they are employed. And to state that “We are finally beginning [italics mine] to interest mental health professionals in the treatment and rehabilitation of longterm patients” belies the sincere and dedicated efforts that have been made over the last 15 years by true professionals in the fields of community placement and repatriation. I agree that staff must not be subjected to administrative pressure to accomplish the impossible. Perhaps the greatest threat to the delivery of sound care for longterm patients is the establishment of arbitrary and unrealistic goals for discharge planning. Furthermore, any quota system that attempts to set in advance the maximum length of stay does not take into account what Dr. Lamb clearly indicates to be the error of believing “All patients can and should be rehabilitated.” The present state of the art just does not lend credence to such a belief. I further agree that treatment staff must have a realistic view of long-term patients and the wide variations in their needs and potential. But even more, this realistic view must be present from admission-way before the patient becomes long-term. Treatment staff need to know much about the patient as an individual in order
to be aware of his needs and potential. Upon admission of the patient, staff need to obtain several kinds of information immediately: identifying information (including ethnic group, occupation, and religion), reasons for admission, data on previous hospitalizations, results of a brief mental status examination to evaluate present psychopathology, the patient’s physical condition and diagnoses for any existing medical problems, his legal status, and a provisional psychiatric diagnosis and tentative treatment plan. Of critical importance is for treatment staff to obtain a summary of anamnesis from the patient or outside informants within four weeks after admission. It will provide staff with significant findings from the patient’s psychosocial and family histories, which are good indications of his needs and potential. Perhaps I am more optimistic than Dr. Lamb about the present and future enthusiasm of those who work with long-term patients. But my optimism is in no way meant to negate the importance of being on the lookout for the possibility of staff burnout. REFERENCE 1) “Staff 396-398.
Reply
Burnout
From
in Work
H. Richard
With
Long-Term
Lamb,
854
is a business officer New York 11754.
HOSPITAL
at
Kings
Park
Psychiatric
Center, 1) Jossey-Bass,
& COMMUNITY
PSYCHIATRY
Vol.
30,
pp.
M.D.
Mr. Meyer’s thoughtful comments about my article elaborated and helped to clarify the important issues involved. Certainly most staff do not get burned out in a year or two where the goals are clear and realistic and the direction of their program is based on a sound understanding of the underlying conceptual issues. And certainly sound conceptual frameworks for the treatment and rehabilitation of long-term patients are available. For instance, the book by my associates and myself, Community Survival for Long-Term Patients, provides one such framework (1). The problem has to do with some new programs that have plunged ahead without conceptualizing both initially and on an ongoing basis what they are trying to accomplish. I also agree with Mr. Meyer that there have been sincere and dedicated efforts over the last 15 years by persons who have devoted themselves to the treatment and rehabilitation of long-term patients. The problem has been that until the past few years these programs were relatively few in number and could not begin to meet the needs of the very large population of long-term, severely disabled patients who are now living in the community. Finally, Mr. Meyer’s emphasis on obtaining detailed knowledge about each individual patient in every area of his life should be underscored for every treatment staff member working with these patients. REFERENCE
Mr. Meyer Kings Park,
Patients,”
San
Francisco,
1976.
