Community Residential Treatment

Alternatives to Hospitalization
  • Loren R. Mosher

Abstract

In a properly designed and functioning community mental health system, community residential treatment facilities should serve the vast majority of disturbed and disturbing individuals in need of intensive interpersonal care who cannot be adequately treated by in-home crisis intervention. Use of these small, homelike facilities in conjunction with 24-hour mobile crisis intervention will dramatically reduce the need for psychiatric beds in hospitals (Hoult, 1986; Langsley, Pittman, & Swank, 1969; Mosher, 1982; Stein & Test, 1985). That is, a 100,000 population catchment area will need, at most, a 10-bed adult ward in a general hospital. This estimate presumes the existence of separate facilities for children and adolescents, the addictions, and geriatric cases. We also presume there will be no backup state hospital beds. This estimate also presumes that the system will have affordable transitional (halfway, quarterway houses) and nontransitional (e. g., group homes, Fair-weather lodges, foster care, apartments) supported (supervised) and unsupported housing readily available for its clientele’s use after the intensive care phase. Without adequate numbers of these facilities users will get “stuck” at home, in hospital, in alternatives to hospitalization, or in shelters. This is both clinically unwise and unnecessarily expensive (Mosher & Burti, 1988).

Keywords

Residential Care Residential Treatment Mental Health System Crisis Intervention Community Psychiatry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Barton, R. (1959). Institutional neurosis. Bristol: Wright.Google Scholar
  2. Bockoven, J. S. (1963). Moral treatment in American psychiatry. New York: Springer.Google Scholar
  3. Braun, P. B., Kochansky, G., Shapiro, R., Greenberg, S., Gudeman, J. E., Johnson, S., & Shore, M. F. (1981). Overview: Deinstitutionalization of psychiatric patients: A critical review of outcome studies. American Journal of Psychiatry, 138, 736–749.PubMedGoogle Scholar
  4. Burti, L., & Mosher, L. R. (1986). Training psychiatrists in the community: The Italian experience. American Journal of Psychiatry, 143, 1580–1584.PubMedGoogle Scholar
  5. Fairweather, G. W., Sanders, D., Cressier, D., & Maynard, H. (1969). Community life for the mentally ill: An alternative to institutional care. Chicago: Aldine.Google Scholar
  6. Fromm-Reichmann, F. (1948). Notes on the development of treatment of schizophrenics by psychoanalytic psychotherapy. Psychiatry, 11, 263–273.PubMedGoogle Scholar
  7. Gunderson, J. G. (1978). Defining the therapeutic processes in psychiatric milieus. Psychiatry, 41, 327–335.PubMedGoogle Scholar
  8. Hirschfeld R., Matthews, S., Mosher, L. R., & Menn, A. Z. (1977). Being with madness: Personality characteristics of three treatment staffs. Hospital and Community Psychiatry, 28, 267–273.PubMedGoogle Scholar
  9. Hoult, J. (1986). The community care of the acutely mentally ill. British Journal of Psychiatry, 149, 137–144.PubMedCrossRefGoogle Scholar
  10. Kiesler, C. A. (1982a). Mental hospitals and alternative care: Noninstitutionalization as potential public policy for mental patients. American Psychologist, 37, 349–360.PubMedCrossRefGoogle Scholar
  11. Kiesler, C. A. (1982b). Public and professional myths about mental hospitalization: An empirical reassessment of policy-related beliefs. American Psychologist, 37, 1323–1339.PubMedCrossRefGoogle Scholar
  12. Klorman, R., Strauss, J., & Kokes, R. (1977). Premorbid adjustment in schizophrenia: Concepts, measures, and implications. Part III. The relationship of demographic and diagnostic factors to measures of premorbid adjustment in schizophrenia. Schizophrenia Bulletin, 3, 214–225.PubMedCrossRefGoogle Scholar
  13. Kresky-Wolff, M., Matthews, S., Kalibat, F., & Mosher, L. R. (1984). Crossing Place: A residential model for crisis intervention. Hospital and Community Psychiatry, 35, 72–74.PubMedGoogle Scholar
  14. Laing, R. D. (1967). The politics of experience. New York: Ballantine.Google Scholar
  15. Lamb, H. R., & Lamb, D. (1984). A nonhospital alternative to acute hospitalization. Hospital and Community Psychiatry, 35, 728–730.PubMedGoogle Scholar
  16. Langsley, D. C., Pittman, F. S., III, & Swank, G. F. (1969). Family crisis in schizophrenics and other mental patients. Journal of Nervous and Mental Disease, 149, 270–276.PubMedCrossRefGoogle Scholar
  17. Matthews, S. M., Roper, M. T., Mosher, L. R., & Menn, A. Z. (1979). A non-neuroleptic treatment for schizophrenia: Analysis of the two-year post-discharge risk of relapse. Schizophrenia Bulletin, 5, 322–333.PubMedCrossRefGoogle Scholar
  18. Moos, R. H. (1974). Evaluating treatment environments: A social ecological approach. New York: Wiley.Google Scholar
  19. Moos, R. (1975). Evaluating correctional and community settings. New York: Wiley.Google Scholar
  20. Mosher, L. R. (1982). Italy’s revolutionary mental health law: An assessment. American Journal of Psychiatry, 139, 199–203.PubMedGoogle Scholar
  21. Mosher, L. R. (1983). Alternatives to psychiatric hospitalization: Why has research failed to be translated into practice? New England Journal of Medicine, 309, 1479–1480.CrossRefGoogle Scholar
  22. Mosher, L. R., & Burti, L. (1988). Principles and practice of community mental health. New York: W. W. Norton.Google Scholar
  23. Mosher, L. R., & Gunderson, J. G. (1979). Group, family, milieu and community support system treatment for schizophrenia. In L. Bellack (Ed.), Disorders of the schizophrenic syndrome (pp. 399–451). New York: Grune & Stratton.Google Scholar
  24. Mosher, L. R., Kresky-Wolff, M., Matthews, S., & Menn, A. (1986). Milieu therapy in the 1980’s: A comparison of two residential alternatives to hospitalization. Bulletin of the Menninger Clinic, 50, 257–268.PubMedGoogle Scholar
  25. Mosher, L., & Menn, A. (1977). Lowered barriers in the community: The Soteria model. In L. Stein & M. A. Test (Eds.), Alternatives to mental hospital treatment (pp. 75–113). New York: Plenum Press.Google Scholar
  26. Mosher, L. R., & Menn, A. Z. (1978). Community residential treatment for schizophrenia: Two-year follow-up. Hospital and Community Psychiatry, 29, 715–723.PubMedGoogle Scholar
  27. Mosher, L., & Menn, A. (1979). Soteria: An alternative to hospitalization for schizophrenia. In H. R. Lamb (Ed.), New directions for mental health servicesAlternatives to acute hospitalization (Vol. 1, pp. 73–84). San Francisco: Jossey-Bass.Google Scholar
  28. Mosher, L., & Menn, A. (1983). Scientific evidence and system change: The Soteria experience. In H. Stierlin, L. Wynne, & M. Wirsching (Eds.), Psychosocial interventions in schizophrenia (pp. 93–108). Heidelberg, West Germany: Springer-Verlag.CrossRefGoogle Scholar
  29. Mosher, L. R., Menn, A. Z., & Matthews, S. M. (1975). Evaluation of a home-based treatment for schizophrenia. American Journal of Orthopsychiatry, 45, 455–467.PubMedCrossRefGoogle Scholar
  30. Mosher, L. R., Reifman, A., & Menn, A. (1973). Characteristics of nonprofessionals serving as primary therapists for acute schizophrenics. Hospital and Community Psychiatry, 24, 391–396.PubMedGoogle Scholar
  31. Pasamanick, B., Scarpitti, F., & Dinitz, S. (1967). Schizophrenics in the community. An experimental study in the prevention of hospitalization. New York: Appleton-Century-Crofts.Google Scholar
  32. Paul, G. L. (1969). The chronic mental patient: Current status—Future directions. Psychological Bulletin, 71, 81–94.PubMedCrossRefGoogle Scholar
  33. Paul, G. L., & Lentz, R. J. (1977). Psychosocial treatment of chronic mental patients: Milieu vs. social-learning programs. Cambridge, MA: Harvard University Press.Google Scholar
  34. Perry, J. W. (1962). Reconstitutive process in the psychopathology of the self. Annals of the New York Academy of Sciences, 96, 853–876.PubMedCrossRefGoogle Scholar
  35. Phillips, L. (1966). Social competence, the process-reactive distinction and the nature of mental disorder. Proceedings of American Psychopathology Association, 54, 471–481.Google Scholar
  36. Polak, P., & Kirby, M. (1976). A model to replace psychiatric hospitals. Journal of Nervous and Mental Disease, 162, 13–22.PubMedCrossRefGoogle Scholar
  37. Polak, P., Kirby, M., & Dietchman, W. (1979). Treating acutely psychiatric patients in pri-vatehomes. In H. R. Lamb (Ed.), New directions for mental health servicesAlternatives to acute hospitalization (Vol. 1, pp. 49–64). San Francisco: Jossey-Bass.Google Scholar
  38. Rappaport, M., Goldman, H., Thornton, P., Moltzen, S., Stegner, B., Hall, K., Gurevitz, H., & Attkisson, C. (1987). A method for comparing two systems of acute 24 hour psychiatric care. Hospital and Community Psychiatry, 38, 1091–1095.PubMedGoogle Scholar
  39. Rosen, B., Klein, D., & Gittelman-Klein, R. (1971). The prediction of rehospitalization: The relationship between age of first psychiatric treatment contact, marital status and premor-bid asocial adjustment. Journal of Nervous and Mental Disease, 152, 17–22.PubMedCrossRefGoogle Scholar
  40. Stein, L. I., & Test, M. A. (Eds.). (1985). Training in the community living model—A decade of experience. New Directions for Mental Health Services, No. 26. San Francisco: Jossey-Bass.Google Scholar
  41. Straw, R. B. (1982). Meta-analysis of deinstitutionalization. Doctoral dissertation, Northwestern University, University Microfilms, Ann Arbor.Google Scholar
  42. Stroul, B. A. (1987). Crisis residential services in a community support system. Report prepared for the National Institute of Mental Health Community Support Program.Google Scholar
  43. Sullivan, H. S. (1931). The modified psychoanalytic treatment of schizophrenia. American Journal of Psychiatry, 11, 519–540.Google Scholar
  44. Weisman, G. (1985a). Crisis houses and lodges: Residential treatment of acutely disturbed chronic patients. Psychiatric Annals, 15, 642–644, 647.Google Scholar
  45. Weisman, G. (1985b). Crisis-oriented residential treatment as an alternative to hospitalization. Hospital and Community Psychiatry, 36, 1302–1305.PubMedGoogle Scholar
  46. Wendt, R. J., Mosher, L. R., Matthews, S. M., & Menn, A. Z. (1983). Comparison of two treatment environments for schizophrenia. In J. G. Gunderson, O. A. Will, Jr., & L. R. Mosher (Eds.), Principles and practice of milieu therapy (pp. 17–33). New York: Jason Aronson.Google Scholar
  47. Wing, J. K., & Brown, G. W. (1970). Institutionalism and schizophrenia: A comparative study of three mental hospitals 1960–1968. Cambridge: Cambridge University Press.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Loren R. Mosher
    • 1
  1. 1.Addiction, Victim and Mental Health Services for Montgomery CountyRockvilleUSA

Personalised recommendations