Will we save the homeless mentally ill?

Article Abstract:

Although a great deal of discussion has taken place on the plight of the homeless mentally ill in this country, very little has been done about the problem. It must be dealt with, and some definitive actions are outlined to directly address the issue. Recommendations were made in 1984 by the American Psychiatric Association's Task Force on the Homeless Mentally Ill which, unfortunately, have not been implemented. Some progress has been made in New York City, where outreach services have been initiated. A large portion of the services currently offered involve shelters, which may be helpful to some extent, but do not address the underlying problem. Mentally ill individuals tend not to take advantage of such services and are typically not compliant with therapeutic drug treatments. It is suggested that the chronically mentally ill become the primary focus of public mental health organizations. Systems must be implemented which actively engage the homeless mentally ill and encourage acceptance of treatment. The issue of their ''liberty'' is often used to obscure the real issue. The question is not whether or not these individuals have the right to live on the street, but whether society has the right to deny these individuals involuntary treatment. It is important to properly assess the needs of the mentally ill homeless; some can benefit from relatively short-term treatment and housing assistance, while others require around-the-clock treatment for major mental illness, which is sometimes combined with serious substance abuse. Some private sector facilities in California have demonstrated that highly structured residential care facilities can provide adequate care, and yet remain financially feasible. The time for discussion of this problem has ended, and a large-scale operation to address the problem is required now. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Services, Mentally ill persons, Mentally ill, Homelessness, Homeless persons, editorial

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Diagnosis, guardianship, and residential care of the mentally ill in medieval and early modern England

Article Abstract:

People who suffer from mental illness have a history of being persecuted, abused, and neglected. Antiquated manuscripts and texts document an early understanding of the origins of mental illness, and attempts to legislate humane treatment conventions. In England, a jurisdiction allowing the king to take possession of the estate of mentally ill subjects who were unable to manage their affairs has been on the books since medieval times. A distinction was made between "idiots" who were impaired from birth and could not improve, and "lunatics" who exhibited psychotic behavior but could recover. Diagnoses were made and certified in court, on the basis of appearances, behavior, memory and cognizance evaluations by officials and jurors. Causes included physical illness or injury, toxicity, emotional trauma, and social stress. Government attitudes gradually became benevolent towards the care of the mentally ill by the sixteenth century, when the king wished "to imitate and approach as near as may be the offices and duties of a natural father" in providing care for both idiots and lunatics. Physicians rarely played a role in the diagnosis process, but were often treatment providers, taking patients as boarders in their own homes. Private individuals often received custody of incompetent people and their estates and were chosen according to their good intentions and standards. This custody was protected by breach of trust laws enforced by the courts. Reexaminations for the purpose of discharge from guardianship because of recovery were also done in the courts. These records show that mental illness was viewed as a natural phenomenon, not one of supernatural origins, and treated with sophisticated understanding and humanity.

Care and treatment, United Kingdom, England, Mental illness, Mental disorders, Psychology, Applied, Applied psychology, Great Britain

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Midazolam for aggressivity and violence in three mentally retarded patients

Article Abstract:

One severely and two mildly retarded patients who exhibited acute and refractory (resistant) symptoms of violence and aggression responded well to treatment with midazolam. Midazolam is a sedative derived from benzodiazepine which has several advantages for use in the patient who has not been responsive to behavior modification programs. The authors recommend that pharmaceutical treatment be administered only when less dramatic treatment has failed. Midazolam is fast-acting, with intramuscular reaction time averaging between five and 15 minutes and intravenous reaction from three to five minutes. The duration of the drug's effects is approximately two hours and the rate of metabolic clearance and elimination is high. The drug is relatively free of adverse side effects and rates of apnea (temporary cessation of breathing), delirium, nausea and vomiting when used as a post-operative anesthetic are low. Intramuscular injections were administered and in all three cases violent behavior was successfully controlled without side effects. The drug was an effective supplement to the normal course of behavioral modification therapy in these three patients. Midazolam is suggested as an alternative for patients who cannot tolerate other medications such as barbiturates to control episodes of extremely violent behavior.

Evaluation, Contracts, Drug therapy, Mental retardation, Violence, Midazolam

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