Impact, Volume 7, Number 2, July/August 1977 Page: 2
24 p. : ill.View a full description of this periodical.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
Making Decisions (Cont'd.)
Does this person really need hospitaliza-
tion? If we think he doesn't, what will
happen if he commits a violent act after we
turn him away? If we decide to provide
therapy, will we only encourage his
dependence on the hospital?
If this patient has been hospitalized
before, why is he back? Was the last
treatment plan not adequate? Was he not
supported in the community?
Because each patient is a unique
combination of problems and potentials,
these decisions are not easy.
First on the agenda is Anne. In order,
each team member contributes information
for the group's consideration. A social
worker describes Anne's social history; a
physician details the results of the mental
status exam; a mental health worker offers
observations of her behavior on the ward
since admission; a psychologist interprets
her psychometric tests. Then Anne is
brought in, welcomed and introduced to
the group.
Anne---described as "52, white and
married"---has been hospitalized 13 times
during the last three decades. Described as
manic-depressive, she is now confused,
depressed, withdrawn and disorganized.
And her husband has decided he doesn't
want her back when she's released this
time.
Several questions are asked of her: Do
you know what happened to bring you to
the hospital? How are you feeling? What
do you have planned for your future? Do
you have any questions for us?
Anne answers in ways that are popularly
considered characteristic of mentally ill
people. Her replies are often evasive,
inappropriate or contradictory. She waits
several seconds before responding to any
question, but when she does, she speaks
briskly and firmly.
"Have you thought of harming yourself,
Anne?" asks the psychiatrist.
"I thought of throwing myself in front
of a car," she replies quickly.
"Did you think seriously about it?"
"I think life's worth living, don't you?"
Later, the psychiatrist asks Anne about
her plans for the future.
"I hope I die tonight."
After Anne returns to the ward,
decisions are made to run further medical
tests to check for possible kidney and
cardiac problems and to discontinue
lithium and try another medication. It is
also agreed to ask Anne if she will consent
to stay as a voluntary patient when her
14-day order of protective custody expires.
Aware she will lack both income and a
home after her release, the staff considersoptions for Anne's aftercare placement. It's
one way plans for a patient's discharge are
considered simultaneously with the
diagnosis.
It hasn't always been so. In the past,
hospital staff assumed the role of
benevolent caretakers when a patient
didn't want to be discharged, when he had
no family to return to or when the
community didn't want him back.
Then in 1968 the geographic unit
system was instituted in Texas hospitals.
With exceptions for children, alcoholics
and a few others requiring specialized care,
patients were assigned to units according to
the proximity of their hometowns. Now, if
unsatisfactory arrangements for aftercare
cause a patient to return to the hospital, he
comes back to staff members previously
assigned to work with him. Continuity of
care receives prime consideration today.
Most admissions
to the hospital
are voluntary.
Next to be staffed is Mildred, a cherubic
fortyish woman with a pixie haircut and a
crisp red and white pantsuit. Numerous
trips to mental hospitals began for her in
1962 and her suicide attempts number
more than 20. Divorced several years ago
from the husband she put through medical
school, Mildred has two grown children.
She seems preoccupied with status symbols
and to be mourning too deeply for a love
so long lost. The psychiatrist calls her case
that of a "smouldering suicide."
"We can diagnose her problems cor-
rectly and we can treat her correctly," he
said. "But when we release her there's no
guarantee she won't attempt suicide again
and by accident succeed."
The group concurs its best hope is to
see if Mildred will agree to stay voluntarily
in the hospital long enough for treatment
to be thorough.
"Thorough" treatment, however, may
take only a matter of weeks. Team
members refer to the hospital as the place
where the patient's condition is stabilized
and groundwork for recovery is laid. It is
assumed that therapy will continue after
the patient returns to the community.
It is a popular conception that most
mental patients enter the hospital reluc-
tantly and that discharge is difficult. In
fact, most admissions are voluntary and as
many as half of the current patients, says
one hospital psychiatrist, would probablynot leave voluntarily were the offer
presented to them.
Some people try frequently and
desperately to be admitted to the hospital.
A few are so-called "street people" who see
the hospital as a provider of organized
recreation, a change of clothes, clean sheets
and dependable meals. Others are former
patients dependent on hospital routine as a
refuge from the stresses and challenges of
life on the outside.
One patient, evaluated as ready for
discharge, left on a Friday. When his
mother refused to return him to the
hospital the following day, he became
violent, hitting his mother and kicking in a
wall. She finally relented.
Another former patient periodically
quits taking her medication so that she will
"go crazy" and have to return. She knows
that's a sure way to be readmitted. She's
representative of more than half the
returnees who need further hospitalization
because they have failed to take their
prescribed medication regularly.
The next patient has tried several times
in the last year to manipulate his way into
the hospital. This time he succeeded.
John is a nice-looking young man in his
twenties. Records reflect he has been
hospitalized several times before---in 1969
following a bad LSD trip and three times
since then for drug abuse. There have also
been indications of a sociopathic per-
sonality.
When John is interviewed, he denies
having used drugs within the last year. But
he says he's anxious a lot of the time and
gets too emotional. He says he's paranoid;
he sees things and hears things. Finally, he
suggests that electroshock therapy or truth
serum might help him. All in all, he comes
across as a young man trying to act crazy
and only barely succeeding.
After John leaves, several staff members
voice their suspicions that he is really not
mentally ill but is merely seeking refuge in
the hospital to escape trouble he may be in
on the streets for dealing in drugs. Unable
to confirm John's need for hospitalization,
the staff orders more tests.
These three patients are only a tiny
sample of the 5,117 admitted to Austin
State Hospital from June 1976 to May
1977. There were 323 others denied
admission and 4,691 who were discharged.
Each number is a human life. Each
decision regarding admission, treatment
and discharge is an attempt by concerned
staff members to improve the quality of
life for a person unable to cope. If human
concern, thorough testing and continuity
of care mend broken minds, Austin State
Hospital offers the tools for recovery.IIMPACT
2
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
Texas. Department of Mental Health and Mental Retardation. Impact, Volume 7, Number 2, July/August 1977, periodical, July 1977; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1588486/m1/2/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.