Effects of community follow-up on post-hospital adjustment of psychiatric patients

Abstract

With considerable evidence that psychiatric hospitalization alone does not insure post-hospital community adjustment, many assume that improved hospital treatment programs are the answer to the psychiatric patient's successful community functioning. Although institutionalization has demonstrated value in cases of crisis and severe disorientation where a change in the total environment is essential, there is reason to question its effectiveness in realizing the final goal of therapeutic treatment, that of reestablishing the person within the community. The alternative advocated here involves the utilization of the community itself in effecting rehabilitation. The theoretical framework for this research focuses on three main points. The first is that psychiatric hospitalization alone cannot insure an ex-patient's community adjustment. Secondly, even the presently popular alternative of brief, intermittent hospitalization appears to be inadequate in that it also often fosters the institutional orientation of dependency, maintaining the "patient" identity, thus encouraging return to the hospital. Finally, it is proposed that the appropriate alternative in effecting community adjustment is a structured, community-based "follow-up" program which affords the patient support and counseling, but does so independent from the hospital setting.The proposition that psychiatric hospitalization alone cannot foster rehabilitation in the community is suggested by a large number of researches considering hospital treatment and later community adjustment. For example, Forsythe and Fairweather (~96~) found little relation between withinhospital measures, such as ward behavior, and community adjustment, and

Efficacy of psychiatric rehabilitation.

“…The only other investigation of professional follow-up counseling did not report the time period studied, so base-rate comparisons cannot be made (Purvis & Miskimins, 1970). Of interest, however, is the authors' examination of the relationship between amount of patient participation in the follow-up program and recidivism.…”

Evolución de la psicoterapia en la esquizofrenia

“…La terapia de grupo en la esquizofrenia tiene ya una larga historia, desde sus inicios en los años veinte con Lazell (70) y la aplicación de técnicas de discusión en grupo y lecturas de apoyo. La psicoterapia de grupo se ha mostrado similar en eficacia a la psicoterapia individual (71; 72) y en algunos casos más aún (73)(74)(75), aumentando el entusiasmo de pacientes y terapeutas, disminuyendo recaídas y rehospitalizaciones, mejorando cumplimiento, relaciones sociales y funcionamiento global. Kanas (1996) revisa todos los estudios con terapia de grupo encontrando resultados muy favorables sobre todo en el ámbito ambulatorio y más pobre en el caso de grupos durante los internamientos (76).…”

Community Posthospital Follow-Up Services

“…While most studies have shown that rehospitalization rates are lower for individuals who receive aftercare services compared to those who do not (Free and Dodd, 1961;Beard et al, 1963;Hornstra and McPartland, 1963;Mendel and Rappaport, 1963;Greenblatt et al, 1963;Purvis and Miskimins, 1970;Anthony and Buell, 1973;Smith et al, 1974;Winston et al, 1977), other studies show no differences between aftercare and no-aftercare groups (Brown et al, 1966;Michaux et al, 1969;Mayer et al, 1973;Franklin et al, 1975). Kirk (1976) attributes these diverse findings to differences in methodology, outcome measures, length of follow-up, type and size of patient samples, and treatment settings.…”