American Psychosis Read Online Free PDF

or no information regarding that patient’s extensive and complicated medical and psychiatric history. The patients experience a high turnover of underpaid workers in their psychiatric clinics, board-and-care homes, and nursing homes. The annual staff turnover in some nursing homes, for example, is 75%. Five different psychiatrists may oversee a patient’s medication on successive visits to an outpatient clinic. In 1982 Susan Sheehan created a stir when she published a book about a woman with schizophrenia who, over an 18-year period, experienced 27 separate admissions to 8 different hospitals and a total of 45 different treatment settings. Such discontinuous treatment, regarded as aberrant in 1982, is now regarded as the norm. 26
4. Continuity of care, especially continuity of caregivers, is essential for good psychiatric care of individuals with serious mental illnesses.
Just as we have learned that continuity of care and caregivers is important, so too we have learned that medication alone is a necessary, but not sufficient, treatment for most individuals with serious mental illnesses. They also need access to decent housing, vocational opportunities, and opportunities for socialization. The best model that combines all three is the clubhouse model, based on Fountain House in New York City, which was started by six patients being discharged from a state hospital in 1948.
Clubhouses are just what they sound like—houses where mentally ill people come to hang out. A true clubhouse is open 7 days a week from morning until late evening. People do not sleep there, but most clubhouses have an associated housing program where many of the members do live. Clubhouses also have vocational programs with job training and job placement opportunities. Within the clubhouse, the members share the tasks of cooking lunch, answering phones, and keeping the clubhouse running.
Clubhouses have been widely praised for more than half a century. Studies have shown that they markedly decrease hospitalizations and incarcerations and lead to employment for many members. They are also cost-effective. Despite this apparent success, clubhouses have spread slowly across the United States. Sixty years after they began, there are still only about 200 of them, and only some of these incorporate the full clubhouse model. A few are outstanding, such as Fountain House in New York, Genesis Club in Worcester, Thresholds in Chicago, Grand Avenue Club in Milwaukee, Independence House in St. Louis, Alliance House in Salt Lake City, and Gateway Housein Greenville, South Carolina. However, clubhouses provide services for, at most, 1% of those seriously mentally ill individuals who could potentially benefit from them. 27
The major reason clubhouses have not spread more widely is the same reason ACT teams have not proliferated—the disjointed funding system. Medicaid and other federal and state funding sources are rigidly set up to support specific activities such as housing or case management, not to cover a clubhouse that is doing many useful activities simultaneously. It is thus very difficult to fund clubhouses, and as Medicaid regulations become tighter it is becoming more difficult. This became clear in 2010 when the Green Door, an excellent clubhouse that had served mentally ill individuals in the nation’s capital for 30 years, was forced to close because of funding cuts. Sixty years after clubhouses began, there should be 2,000 of them, not 200, and states should be opening additional ones, not closing them down. 28
5. In addition to medication, individuals with serious mental illnesses need access to decent housing, vocational opportunities, and opportunities for socialization. The clubhouse is the best model for meeting those needs.
The majority of seriously mentally ill individuals live in nursing homes and board-and-care homes. Some of these homes are managed by owners who provide residents with decent and humane living conditions. Many others,