Faculty Bibliography

The authors describe New York City's program to remove seriously mentally ill homeless people from the streets to a public hospital. They report on the 298 patients hospitalized during the first year of this program. Most of the patients were male (66%), single (77%), and from outside of New York City (79%) and claimed a history of previous psychiatric hospitalization (92%) and that they had been homeless for more than 1 year (66%). Most of the patients suffered from schizophrenia (80%) and had additional medical diagnoses (73%). Follow-up contact with the patients 2 years after initiation of the program revealed that 55% of the patients either were living in a community setting or were under institutional care

The authors studied the management styles of the 11 directors of psychiatry in municipal general hospitals in New York City. The Lead-Self Scale and the Lead-Other Scale were used. The directors' Lead-Self Scale scores were compared with those of 11 psychiatric residents. Results show that the directors had a high task/high relationship primary style and a high relationship/low task secondary style. Psychiatric residents revealed a less differentiated pattern of self-perceived management style. The authors speculate about the effects of experience, training, role models, and personality traits on management styles and suggest areas for further research

The presence of two separate languages, each with its own lexical, syntactic, semantic, and ideational components, can complicate psychotherapy with proficient bilingual patients. If only one language is used in therapy, some aspects of the patients emotional experience may be unavailable to treatment; if both languages are used, the patient may use language switching as a form of resistance to affectively charged material. The authors suggest that monolingual therapists should carefully assess the degree of language independence in bilinguals in order to minimize its impact on therapy. They conclude that study of bilingual patients may provide important insights into the nature of the therapeutic process.

OBJECTIVE:Dramatic increases in lengths of stay for general hospital psychiatric patients in New York City in recent years have raised speculation that general hospitals are assuming a large responsibility for care of the chronically mentally ill. This study examines changes in utilization patterns and patient characteristics to assess whether such a trend is occurring. METHOD/METHODS:The authors obtained discharge abstract data for all New York City general hospital adult psychiatric patients in 1985 and 1988 as well as utilization data from the public general hospital system for 1977-1989. Three measures of chronicity were chosen: hospital stays longer than 60 days, discharges to long-term care, and three or more admissions per year. Data on psychiatric diagnoses and comorbid diagnoses for chronically ill patients were also reviewed. RESULTS:The mean length of stay of psychiatric patients in general hospitals has increased substantially in recent years and nearly tripled in the public hospitals during 1977-1989. Between 1985 and 1988, citywide increases were due largely to a growing proportion of patients with very long stays. Patients with stays longer than 60 days accounted for 35% of all inpatient days in 1988, compared with 27% in 1985. Patients with chronic illness accounted for half of all days in 1988, compared with 38% in 1985. CONCLUSIONS:Although many factors have contributed to these trends, the leading cause has been reimbursement policies favoring short-term inpatient care. Improving accountability for community treatment programs will be the key to redirecting funding priorities and creating more appropriate alternatives for the chronically mentally ill.