Search for mental health; Community psychiatry: What is done?

The Forest Hospital located in displaying the lanai 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 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. Morris Squire administrator of Forest Hospital. This is my school. My special guest for today is Dr. Daniel Lieberman. Who's a psychiatrist in Wilmington Delaware. He happens to be the commissioner of the Department of Mental Health for the state of Delaware Delaware an associate professor of psychiatry at Jefferson Medical College in that state. Tell

me Dr. Lieberman you have had a great interest in Community Psychiatry in the past and I think you still are and must be as a commissioner of the problem mental health. What kinds of new things are occurring today in Delaware. Well exciting things are happening in Delaware as elsewhere in the field of Community Psychiatry. Perhaps the most striking is the utilization of nonprofessional or sub professional personnel in the care and treatment of individuals with with mental disorders. People who are not skilled or trained in the field of psychiatry can through special interviews training programs gain a degree of

understanding and a degree of skill and dealing with people in trouble especially people in stress. So that is a part of the Crisis Intervention Program. In Delaware which is a part of AA emergency service which is a necessary complement of a community mental health service program is the program that's available throughout all of Delaware. No at this time it's not it's available only in the Southern woman into an area. And it's available throughout Delaware on a partial basis that is to say there are times when such a service is available but it's not available throughout Delaware on a 24 hour day seven day a week basis. That's to come. That is to come hopefully it is to come. Getting back to the sub professional person this this individual

can be located here and spots in the community who are trouble may arise. And this person can through communication with a professional person located elsewhere. Receive instructions as to how to handle a particular situation. I happen to be a consultant to Jefferson Medical College which is setting up its own community mental health center and there every striking development is occurring that is two way radio system between this contact person on the spot with a professional person staying within the medical center. We're at the spot at well this part can be in any one of several places usually it's located in a slum area. It's usually located

near where. Near a police station. Or it may be located in a service kind of facility where people in trouble tend to come anyway. What kind of service. So it could very well be and in some cases it could be the emergency room of a general hospital. That sounds like a logical place. In other cases. It could be where there is a large congregation of people who are demonstrating. And other cases it might be. Where there is a large social gathering not for purposes of demonstration but for purposes of entertainment where sometimes things may go right just now in fact and

is now operative. This is not really an operative in any in any well organized sense. It is a plan. This is a plan and it's in its initial phases. Actually the people are now being trained. To participate in such a program and this is of course also is associated with the kinds of services which would help people who are in trouble in terms of there being potential suicides or in trouble in terms of there being possibly harmful to others. Who are these people who you are training are they clergymen are they policemen are they nurses who are writing. Well the sub professional person that we have

been trying to select. Are those people who are sensitive to the requirements of other human beings for the basic needs of life. There are people who are reasonably intelligent sometimes they are college students. Sometimes they are housewives. Sometimes they are people who. Are working in another capacity but feel that theyre not contributing to the. Social community to the extent that they would like to. We like people not so much on the basis of their. Of their background as on the basis of their sensitivity and understanding alertness and courage and love of their fellow man. Well that sounds like the same kind of thing that was said back in

1812 via a man who had founded the retreat Institute New York near York in England. He said the same kinds of things about people. He wants this kind of person as his orderly or as his care taker for his patients. You mean to tell me that the needs are still the same for the treatment of psychiatric patients. This is 18 12 this is 1967 Dr. Lieberman. Yes it is true that the basic requirements of people remain the same. And these days the illnesses that we see or more complex and more complicated certainly the specific treatment of the mentally disordered individual must be a medical psychiatric treatment in order for the individual to recover.

But for the purpose of interceding in a crisis for the purpose of getting a person into treatment for the purpose of preventing a suicide. Yeah you can't treat a person when he's dead. We certainly can utilize more difficult although it sometimes give me more successful. Tell me after you have selected this this and this cadre of people and they will be put in radio cars or in radio contact or in developmental systems within hospitals or within emergency floors or on the floors of boxing arenas or in an all night laundromats which I think is a good place to put people who have emergency problems or in the local train station or wherever you put people who will be able to pick up the problem as it occurs in the community or whether it's going to be what happens at Beijing.

I'm here I am sick I have a letter to tell somebody I'm sick somebody found out I'm sick OK what happens. Well this person must be you. You must have access immediately to a psychiatric or medical assistant. Why. Because. At least at this time the most skilled person is able to deal with sickness is a trained medical doctor who is a psychiatrist and sometimes of course the individual is not ready to accept treatment in which case other methods must be used to help the person to avoid self disaster. By that I mean if an individual refuses to accept treatment it's certainly his right to do so. Unless his irrationality is of such a degree that he's in no position

to to make a judgement. And unless it is fairly apparent it is apparent that he could be harmful to himself or possibly others under these conditions we do have to intervene even if it's not the wish of the person that treatment take but you don't need a psychiatrist to tell you whether or not you know if you're a trained technician. For instance you see the patients you are or the person who you're attending to at that moment says I want to commit suicide I'm going to try to commit so that I could jump out a window or going to kill myself with his gun or his neighbor's music lies. You don't need a psychiatrist to tell you the guy needs help. No certainly not. And you could very well as a citizen and somebody with special skills could you send this person to a hospital or an X facility that would be able to care for this person. That's true you know many states have. Emergency apprehension laws which allow concerned citizens to make such a step. What usually occurs

is as you or I see a person who looks like he's seriously ill and may hurt himself or others as a concerned citizen. We feel that something should be done. What we would do would be to call a police officer as a general rule so-and-so is going to kill themselves. This story's going to hurt somebody else. The police officer comes in. The person who has observed the behavior submit a report to the police officer the police officer then reviews the situation and so if he is in substantial agreement that this is a disturbed person then he takes this individual to a medical doctor or to a facility which can retain him observe him for a period time now usually the time that such a person could be held against his will is about 72 hours it varies kinds from state to state. And during this period of time he is observed and evaluated. And then

the physician will. This is usually done by a physician or psychiatrist. I will then make a recommendation as to the subsequent course of treatment within the church period time the person may have recovered and be able to return home. Or he may require hospital treatment in which case he is asked to voluntarily submit himself to treatment. How is your system different in the US. How is your system going to be different. This is a contact person to be able to do something different for the patients. I don't think so I think what's going to happen is that as a result of the contact person this kind of thing will be able to take place rather than the person being thrown in jail which is what happens. So will the policeman necessarily have to be used in your kind of situation. Not necessarily would depend depend entirely upon the willingness of the individual to accept service.

I see so it could be a short cut and better system actually. It could be Dr. Lieberman is it your hope that the community mental health will then come closer to the person who's in need assets and being out in the boondocks in the old state hospital system. I believe so. I believe that with the kinds of programs being developed that. People will be become more aware of the availability of service and will seek treatment sooner. I think one of the very wonderful prospects and community mail services is in the area of consultation services to schools and to other agencies that do would individuals any agency or group to deals with individuals is also going to be dealing with individuals who are in trouble who become emotionally disturbed or disordered through a proper consultation service. The agency dealing with people for example a school becomes

sensitive to the impact of its program upon the mental status of the individuals the deals with. So that in the field of education then a mental health component can be built in which will promote mental health in the school. Very good. In regard to education and mental health in the school how do you feel about sex education in my school. Sex education will have to be developed in the school. Because by and large the home environment and the church environment is not adequate at this time to do the job. It's unfortunate that we have to focus on sex education specifically because I believe that understanding's and knowledge about sex should be a part of the general knowledge of the

individual as he grows or learns. I don't like the idea of sex being separated out as a focus of learning but this is perhaps what has to be done at least at the beginning until our general attitude toward sex becomes so relaxed that it becomes an integral part of the learning process. What do you mean by that. I mean that for example the child as a part of his communication with his parents and others should be able to discuss sexual matters as they occurred to him just as he would discuss others. For example the young child that sees the enlarged abdomen of his pregnant mother may be in a good position to receive information from his mother about the biological process of conception and birth. This would be a natural time for a

child to learn this sort of thing rather than to segregated into a special classroom setting. How did children identify really who they are and what they are sexually. Well there they identify themselves primarily as a result of how their parents treat them. As a general rule if the child is a boy the the parent will raise the child as a boy. If the child is a girl the parents will raise the child as a girl. As a general rule but unfortunately and frequently because of conscious or unconscious wishes of parents to have a different kind of child that is a boy when they have a girl or boy or they wish to a girl when they have a boy they will treat the child as if he were of the opposite sex. And this has a profound influence on him as I say this can be done unconsciously as well as consciously and then the other attitudes

of parents toward children in regard to their love relationships. Excites a development along one gender or another. So that my response to the question is that sexual identification is primarily the result of the attitude that the parent presents to the child in regard to his sexual identity. Well what if. There is a medical situation where the child has a mixed kind of physical sexual identity at birth. What happens if you raise the child in the non dominant sex. As a general rule the child will assume the sexual identity that he is raised with. There is some

evidence to indicate that there may be biological forces at work which in spite of the attitude of the parent will make the child believe he is really of another sex. So we cannot completely discount the biological forces as they do exist and there's evidence to indicate that they do have an effect in many cases. Dr. Marmion one of his papers most recently said that if a child who is this way equated this way non so that you can't really tell what the child is realistically. If it's raises a boy and really is a girl. When you finally find out that it's a girl it's safer to continue on with the boy role as such because the razing as you intimated in your opening comments was what counted as far as a child's picture of himself is

concerned how he thinks of himself what she thinks of herself in what sex category they put themselves as you know you give pink dolls to the little girls and you give trainings to boys. And so the set that you put on the child sometimes has a definite effect and I'm not sure if these were his statements and so I can only take them as another physician's word us. And your experience in this and some of your recent comments on homosexuality I would wonder if you'd like to comment on on this. As a whole. Well I would agree with with Dr. Marmor in general although as I said there there have been described cases where the end of the child was raised as one sex but had some inner urges indicating that he believed himself to be of another sex or at least was confused about his sex. Now whether or not his sect should be changed through surgical procedure and otherwise would depend upon how he viewed himself.

And therefore I would agree with Dr. Marmor that if he viewed himself and identified strictly in an and 1 sexual category then that's where he should remain. What about our attitudes about sex. Well there's no question but that our our attitudes in the last 10 or 15 years have become more free and more open and at least among a minor segment of society which is a significant segment of society. They have been become altar free that is a big income quite a licentious in my opinion. How so that the traditional attitudes toward sex not only are being reversed but in a sense as sex is becoming dehumanized. Among this relatively small group. Are you talking about the homosexuals in the city.

No one to talk about the homosexuals I'm talking about. The sexual cult that believes in complete promiscuity and use the sexual act as as purely a physical act. Which is carried out only as a result of a pleasure or motivation for the moment and doesn't bring in any of the other human values which we usually think of as elevating the entire sexual act. I see the love part of the sexual act the love part of the sexual act which is so important seems to be missing among this cult. We use a psychiatrist What importance do you put upon the love part of the sexual act as compared to the sexual act. I believe it is of extreme importance even though the love may be a transitory one.

I'm not talking about the long lasting love that a man may have for his wife but even if it is if it's falling in love for the evening. There there has to be that love feeling for the sexual act to be a act of importance and meaning to both people. We didn't touch too much of on what was actually what is our attitude towards us today. Again there is some relaxation of our puritanical attitude toward homosexuality. However we must remember that it is a disorder it is not a a normal plane. Certain individuals who have confused sexual identity are amenable to treatment but most too are strongly identified as homosexuals wish to remain that way. Without treatment. Thank you very much Dr. Daniel Lieberman who is the commissioner of the potman the mental health of Delaware and is an associate professor at Jefferson Medical College. And this is more squire

for further information regarding this subject. Please write to this station or to force hospital explains on why. You have just heard another in the series the search for a mental health hospital in display in cooperation with this station. In this series the citizens and other professional personnel working in the area of mental health at Forest Hospital a hundred bed treatment facility well discuss the latest advances in mental health care research and education. Other topics such as alcoholism adolescent behavior problems problems of the aged and others will be presented on the search for mental health. The host for this series is Mr. Morris Squire administrator of Forest Hospital. The search for mental health is produced and directed by Jacques. This program was distributed by the national educational radio network.