Search for mental health; The importance of the family

The earlier Forest Hospital located in displaying the Illinois presents the search for mental health and exploration of the newest advances in psychiatry during this series. Physicians and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed treatment facility will discuss the latest advances in mental health care research and education. Such topics as alcoholism and adolescent behavior marital problems problems of the aged suicide emotional problems and others will be presented on the search for mental help. Your host for this series is Mr. Moore Squire administrator of Forest Hospital. This is Mara squire at the American Psychiatric Association meeting in Atlantic City New Jersey and we have a special guest today. Yes this is Mrs. Imogene young. A master's in social social work

who is an associate professor of psychiatric social work at the psychiatric institute at the University of Maryland School of Medicine and she's a doctor Oreo candidate also a social worker and her doctor or research is a very special subject. Jane Adams and her career and her career and her concerns in child welfare and I suspected her concerns and shout were all for. I have even more evidence today we have many more concerns and what we're going to do with the adolescent population and the children who we want to keep and a healthy society. Mrs. Young. I wonder if you could give us a little bit of history and also the kinds of things that made your particular hospital a psychiatric institute devise a program called pre admission home visits. Well we've always been very much interested in and concerned about the families of our patients. And

there are a number of reasons for this. One of these is the family certainly has that many needs also. They have been trying for a period of time to misperceiving receiving. And Mr. thieving again but trying very much to understand the nature of this problem area. And once it's been identified then the family along with the patient can struggle with or thought the things folk beliefs. Such as perhaps it's a hospitalizing. Oh he'll never get out. Putting away once and saying always and saying oh that maybe this is defined as a mental illness. He will never be able to. They can never expect that he'll be well again. The family

quite understandably have so many feelings about what they may have done or are not done. That may have contributed to this problem. And. I wonder too how much of this is really a family affair and that which the symptoms are showing up in just one of us and therefore do we all need to really be involved in examining this problem. Do you think about one woman flying a squad for emergency admissions of patients then. Well I wouldn't say exactly so because as we patients are referred to Dr. Walter Weintraub who is the director of our inpatient division. And he decides that certain ones should profitably have a home visit.

Usually as I go out I'm accompanied by at least two of our medical students who are functioning as student doctors around the psychiatry service and sometimes by one of our masters candidates in psychiatric nursing at the University of Maryland. You have a job that we have a real team and now this team go out like a crisis intervention and try to question intervention of the time we're using back in Illinois today. When you go out and do right now. Well certainly any team going into a the home of an individual who has been defined as a home psychiatrically L is helping right on the spot. Our primary goal however in this trip mission home visit program is not to institute a therapeutic program but rather to

bring to secure additional information that may be helpful in deciding whether our hospital is the best hospital for those patients. R should some community perhaps be recommended to him. But the other going back to treatment. I love the way you bring this up because it isn't. We do not see it as primarily a crisis treatment program but certainly something happens as one goes into the homes that. Is that the therapeutic nature. At least they tell us. No family you're calling upon you're really in a very critical time in their history as a family. And if you go to their home you can suspect stock something is there and if you don't feel the patient needs to be house by the suspect you can make it very well known right there. So some patients who never have to come to a hospital but when I get in there it's all brought back in to Dr. Weintraub and he is staffed

and very carefully evaluated along with all of the data that may have been available concerning this patient at the time he was referred and the patient still has to wait for this is whether or not he can kind of you not see how long the waiting on the list before he gets a home visit. Well there is great variation here. But Dr. winder makes it clear to the referral Thore and hopefully this gets the patient through that the wait could be as long as 10 days or two weeks. Because of the availability. The paucity of beds and the fact that a bed isn't going to be available for a longer period than that. I got a call the patient that day I don't want you to think I got a question right away I had two weeks to sit there and you call me and I can sit there for 10 days or two weeks what do you do then. Any patient who is that acutely becomes in need of hospitalization would be admitted if not to our

hospital to some hospital certainly but there are people who care who are selected and can wait and can wait and I see right now in your treatment in the valuation approach and you have also a training approach you bring in to make a nurse who is in training so they get to see the family in actual conflict if that's a part of it or see how a family lives or who is the patient really in the family or the whole whole family a patient to do any family therapy by the way in the hospital. Oh yes. And some of our psychiatric residents were senior staff too but some of us psychiatric residents are very much interested in family therapy and with the kind of foundation that is laid for involvement of a whole family. Perhaps all those who live in the household and sometimes even the extended family come into this. I think

you had to graduate in May and then very early in the patient's admission. Add to this the information that was available earlier and reach a decision that he would he may want to involve the whole family in treatment. As a social worker. Tell me what you think is the difference between family therapy as it's now constituted casework and girl fashion social work. This is a question for Thalmann but it is to just break it down. Well fashion casework our own fashion. Supportive treatment regardless of the who may be the helping person. I was not necessarily addressing itself to do a whole family.

Certainly historically parents have been involved if the primary patient was. A. The woman her husband might be involved has been about. But that didn't necessarily bring in. And in the case of adolescent and mother our adolescent father one or both parents who might've been involved in in a support a supportive relationship in order to deal with problems in the relationship between parent and child are between husband and wife. Family therapy looks that really no one as the primary patient but really at the whole group and out and involved. All of them.

Well is there a difference in diagnosis and treatment. Are we saying really that family therapy as it's now constituted is diagnostically a family process whereas as a caseworker used to look at the family used to say well we're it's a family process but I can see the whole family for diagnosis as such. But I would treat the whole family. She never excluded anybody else out the social worker or exclude any pot any member of the family. Were they forbidden to come in. She might not have wanted to. But the concept may not have integrated the concept of treatment as it was mapped out may not have made all of the members of the family an integral part of the treatment program. I think that you're asking specifically whether there

is a difference in diagnosis. Is it is extremely important because I do think there's a difference if Family Therapy is. It is to be the treatment modality. The diagnosis that is based on. The. Many considerations and components of the of the total family. Picture. I'm bringing you back to your pre admission home visit I'm asking you what are you doing. Are you doing family. Family diagnosis really. Now I'm a social worker used to visit the home she did the same thing she saw the family. She found out how much money there was was what papa did with Mama did how the kids were what happened with the family and why the kid got sek she did the same thing. So that was family diagnosis. Now if you want to change the label call it now family therapy. That's fine. I'm going to agree with you I'm just trying to find out what's so different about what's happening now as to what happened previously under

different labels. Well. I be too technical but I think one does have to try to be quite precise. If it's an attempt to be precise anyway and I would say this as a psychiatric social worker and. I wish we had a psychiatrist with us to say I give his opinion too. But I would say that for a long long time that we were a family oriented and we certainly involved one our significant other people in the patient's life in the period of study and evaluation as well as in the treatment program but not. It was not. Seeing the family as the basic unit to be diagnosed and treated much as I wonder if you'd talk a little bit about the hurt to the heritage of social work

and where we're going with it. Well that's a broad question and a wonderful one. And I think that in 1956. We very much yeah. Drawing upon and utilizing the the concepts and the practical pioneering work of the early social workers which began before the long before the turn of the century and perhaps long before that. Social work. From this this very distinguished group among whom Jane Addams that very served in a very prominent role was very greatly concerned then and now with the conditions of the community and

in what way. All of these environmental stresses had bearings on some of the dysfunctioning of families and of individuals within the family. And. That that point casework as a method of helping was not that. As scientifically developed. As it later became the case with the rise of Mary Richmond and her formulation of social diagnosis and social treatment. I suppose I've gotten a really kind of digressed here from what you really asked but maybe what you really want to know is. What social workers do right now and what to doing now and where are they going with this. Well social workers are certainly very much

involved. Still in work with the individual work with or with families and in trying to bring about some shifts and changes too. In the community. And if institutions you can look at all of the current social legislation and and see the tremendous emphasis being placed on not necessarily by entirely on the intra. Psychic processes but on Nath What out here makes for. A full stomach and a. Warm. And. Adequate Housing and adequate schools and so forth. Well commies the social workers cry I'm going to be a therapist. So we have to be pay attention to because there are so many social workers today who are no longer do

ordinary case work but are doing psychotherapy. You can call anything else. How do you feel about this. Well I don't think this is a cry Exactly and I don't think it's it's new at all. I think that the timeliness of your question undoubtedly stems in part from the very strong recommendation of the Joint Commission on Mental Illness and mental health that. All persons. Across the board in the disciplines who had. Some. Who had knowledge and skill which could be used in the pooling of all efforts to try to solve the urgent problems of our time in mental in mental illness and in in to prevent event event in human intervention and in promoting mental health should be used. And this as you know is very strongly emphasized. But the.

Some social workers have for a very long time been interested in developing ever there and refining their skills in treatment and in. Functioning as a wealth. Some even as you might say is as well a therapist under the. Supervision. Of a psychiatrist who had legal sanction to offer. The fat lady therapist. You know I mean that as a social worker needs legal sanction to do there. We are not talking about a medication we're talking about there. Now tell me if you really feel this. There are social workers who have offices who do full time psychiatric practice as such. They may call it social work and call it something else but they're in full time practice.

Well if we're just we're not talking now about psychotherapy but we're talking about let's say supportive casework treatment. This is recognized by the National Association of Social Workers as appropriate. And. There are many many committees working on this and there are individuals who are. Social workers who are offering help to troubled people. The problem felling nature who are not working under the supervision. A physician I think I. How do you mally that was trying to you know relate this to really two psychiatric services rather than to a broad picture out here in the community. And but I haven't yet told you how I feel about it. OK.

I have the bias you might say of being an educator and of always having been involved in in education social work students and. Of medical students primarily and in a training center. It really is awfully important that the learners in in the various fields understand that which each discipline is most expertise in. And it's hard enough for a person coming in let's say with a psychiatric service to integrate so much so many complex aspects of the complex illness. But to add confusion about that all the disciplines do the same thing across the board. I don't think it makes for good sound.

Education. Yet you follow the protocol set forth by the. Government saying that we should use as many available therapist as possible and I'm just really you know reverb ally's ing I'm putting it back to that. You can't very well sit on both sides of the fence. You have to say if you're a therapist or if you're not a therapist you have to say also what kind of therapy you want to do or what ever you don't want to do. I don't care what you call a black white or grey therapy's happening. If there IS HAPPENING I suspect you have to accept it as a social worker and you say well we're working out what we're going to call it. Well tell me where it begins and where it ends. I don't know yet. The important issue here is that. Every day in my opinion is that. There not be any confusion about what an individual is doing. I think it's awfully bad and certainly all during World War Two

major objective was to win the war and to use every single person who could be used and has a very important common denominators with joint Commissions report in this effort. And we really weren't too concerned then about some of the concerns that I think a very valid not being a pseudo psychiatrist and or a watered down psychiatrist. Our concern then was to have everybody in there pitching under the leadership of the physician heading up the unit and everyone did what he could and we were quite sure that more good came out of it than anything else. Maybe we're in some a situation somewhat of the same so what right now. But I do say that it is. It realistic and it's very unsound and unproductive to think for everyone to be so enamored of. Like it sort of like having it given on a silver platter doing exactly what the

psychiatrist does when in my opinion social work in its own right has a tremendously rich heritage and current currently developed body of knowledge. And skill to offer which has some important differences from that which medicine has and which should make a rich contribution to our society. That's a very fine statement I'm in total agreement with that. And I wish that social worker would so who would continue along the same lines reference that you speak speak about now and I want to thank you very much. This is Imogene young. For being on our program. This is Imogene Young is an associate professor of social work at the psychiatric institute at the University of Maryland School of Medicine in Baltimore. And. She's now working on her doctorate pro-oil

candidate. Very interesting topic. Factorial research is on Jane Adams and her concerns and Cheryl for thank you again and I'm Our squire. You have just turned another in the series the search for a mental health produced by Forest Hospital in this plains Illinois in cooperation with this station during this series that this ins and other professional personnel working in the area of mental health at Forest Hospital. A hundred bed treatment facility will discuss the latest advances in mental health care research and education. Other topics such as alcoholism or adolescent behavior marital problems problems of the aged and others will be presented on the search for mental health. The host for the series Mr. Morris Squire administrator of Forest Hospital the search for mental health is produced and directed by Jack regatta.

This program was distributed by national educational radio. This is the national educational radio network.